Individual
DR. RYAN FREDERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3004 28TH ST SW, GRANDVILLE, MI 49418-2704
(616) 534-5602
Mailing address
2003 LAKEWAY AVE, KALAMAZOO, MI 49001-5123
(269) 383-1592
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901020396
MI
Other
Enumeration date
05/23/2011
Last updated
05/23/2011
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