Individual
DR. JACK C. FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1930 MESQUITE AVE, STE. 8, LAKE HAVASU CITY, AZ 86403-5674
(928) 855-4347
(928) 855-6894
Mailing address
2061 BRYCE CIR, LAKE HAVASU CITY, AZ 86406-8352
(928) 855-6505
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2079
AZ
Other
Enumeration date
03/22/2006
Last updated
07/13/2026
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