Individual
FREDERICA MACKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(804) 828-9190
Mailing address
2121 GROVE AVE APT 4, RICHMOND, VA 23220-4561
(425) 761-7354
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0411000065
VA
122300000X
Dentist
DE60757254
WA
Other
Enumeration date
05/10/2016
Last updated
07/27/2022
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