# FREDERICK DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871628370
- **Authorized official:** DR. DONALD FREDERICK III (SOLE PROPRIETOR)
- **Authorized official phone:** (570) 829-2691

## Contact information

- **Practice address:** 44 S MAIN ST, WILKES BARRE, PA 18701-1705
- **Practice address phone:** (570) 829-2691
- **Mailing address:** RR 3 BOX 155, HARVEYS LAKE, PA 18618-9403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 19534-L | PA | Yes |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 08/22/2020