Individual
LEE DAVID FREDERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3004 28TH ST SW, GRANDVILLE, MI 49418-2704
(616) 534-5602
(616) 534-4538
Mailing address
3004 28TH ST SW, GRANDVILLE, MI 49418-2704
(616) 534-5602
(616) 534-4538
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
09607
MI
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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