Individual
FREDERICK ANTHONY FENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3150 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 445-7051
(928) 778-1731
Mailing address
3150 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 445-7051
(928) 778-1731
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
42820
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-4566
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
589393
ACCESS
AZ
Enumeration date
08/19/2006
Last updated
07/08/2007
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