Individual
DR. FRED RODEMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1947 RIDGE RD, WEST SENECA, NY 14224-3339
(716) 675-9777
Mailing address
22 S BUFFALO ST, SPRINGVILLE, NY 14141-1239
(716) 592-9269
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
36553
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020919401
UNIVERA HEALTHCARE
NY
05
—
00832155
—
NY
Enumeration date
06/16/2006
Last updated
01/22/2015
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