Organization
FREDERICK DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD FREDERICK III (SOLE PROPRIETOR)
(570) 829-2691
Entity
Organization
Contact information
Practice address
44 S MAIN ST, WILKES BARRE, PA 18701-1705
(570) 829-2691
Mailing address
RR 3 BOX 155, HARVEYS LAKE, PA 18618-9403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19534-L
PA
Other
Enumeration date
02/23/2007
Last updated
08/22/2020
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