Individual
MALIA FREDRICKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
10229A CLEMSON BLVD, SENECA, SC 29678-0817
(864) 882-0620
Mailing address
3 TRAILS END, GREENVILLE, SC 29607-1738
(864) 882-0620
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3260
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9819
—
SC
05
—
ZX3260
—
SC
Enumeration date
06/18/2006
Last updated
07/09/2007
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