Individual
DR. JACK C. FREDRICKSON
Active
Sole proprietor
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
07/08/2007
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