Individual
DR. FRED RODEMS
Active
Individual
DR. FRED RODEMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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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