Organization
DENT-U-CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEE DAVID FREDERICKSON DDS (OWNER)
(616) 534-5602
Entity
Organization
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
122300000X
Dentist
12554
MI
Other
Enumeration date
07/24/2008
Last updated
07/24/2008
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