Organization
DR FREDERIC CLYDE RATHER DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERIC CLYDE RATHER (DENTIST)
(219) 836-5656
Entity
Organization
Contact information
Practice address
9042 COLUMBIA AVE, SUITE A, MUNSTER, IN 46321-2905
(219) 836-5656
(219) 836-0455
Mailing address
9042 COLUMBIA AVE, SUITE A, MUNSTER, IN 46321-2905
(219) 836-5656
(219) 836-0455
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12008608A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447260732
INDIVISUAL NPI
—
Enumeration date
10/19/2006
Last updated
08/22/2020
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