# DR. NICHOLAS ANTHONY FREDERICKA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1790904589
- **Gender:** Man
- **Credential:** D.M.D

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 30016140 | OH | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 07/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0493729 | — | OH |
| 01 | — | 196764 | UNITED CONCORDIA INS. ID\# | OH |
| 01 | — | 341352009 | DELTA DENTAL INS PROV. ID | OH |
| 05 | — | 341352009027 | — | OH |