Organization
FREDRICK W WICKNICK DMD INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDRICK W WICKNICK DMD (PRESIDENT)
(360) 671-4859
Entity
Organization
Contact information
Practice address
3136 SQUALICUM PKWY, SUITE #B, BELLINGHAM, WA 98225-1954
(360) 671-4859
(360) 671-3010
Mailing address
3136 SQUALICUM PKWY, SUITE #B, BELLINGHAM, WA 98225-1954
(360) 671-4859
(360) 671-3010
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DE00006347
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08367
WDS
WA
01
—
581903
UNITED CONCORDIA
WA
Enumeration date
05/01/2007
Last updated
11/19/2007
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