Organization
NICHOLAS A. FREDERICKA D.M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS ANTHONY FREDERICKA D.M.D (PRESIDENT)
(330) 652-6500
Entity
Organization
Contact information
Practice address
822 ROBBINS AVE, NILES, OH 44446-2432
(330) 652-6500
(330) 652-6550
Mailing address
822 ROBBINS AVE, NILES, OH 44446-2432
(330) 652-6500
(330) 652-6550
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30016140
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0493729
—
OH
01
—
196764
UNITED CONCORDIA INS. ID#
OH
Enumeration date
04/24/2007
Last updated
08/22/2020
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