Individual
DR. DONALD A FREDERICK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
44 S MAIN ST, WILKES BARRE, PA 18701-1705
(570) 829-2691
(570) 829-2790
Mailing address
RR 1 BOX 289, HARVEYS LAKE, PA 18618-9760
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19534-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126020
UCCI PROVIDER ID#
PA
01
—
156744
UNISON PROVIDER ID#
PA
Enumeration date
02/23/2007
Last updated
07/08/2007
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