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Individual

DR. NICHOLAS ANTHONY FREDERICKA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.M.D

Contact information

Practice address
120 BOVARD ST, YERINGTON, NV 89447-2437
(775) 463-1800
(775) 463-4810
Mailing address
120 BOVARD ST, YERINGTON, NV 89447-2437
(775) 463-1800
(775) 463-4810

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30016140
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0493729
OH
01
196764
UNITED CONCORDIA INS. ID#
OH
01
341352009
DELTA DENTAL INS PROV. ID
OH
05
341352009027
OH
Enumeration date
04/24/2007
Last updated
07/25/2008
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