Individual
DR. GLENN M. FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
37 S CANTERBURY RD, CANTERBURY, CT 06331-1520
(860) 546-9434
Mailing address
PO BOX 487, CANTERBURY, CT 06331-0487
(860) 608-2334
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5093
CT
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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