Individual
LISA FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 LAMBERTON RD, WINDSOR, CT 06095-2149
(860) 688-3663
Mailing address
79 WRIGHTS POND RD, WESTBROOK, CT 06498-1458
(860) 575-4196
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12734
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2019
Last updated
08/20/2020
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