Individual
JONATHON KARL FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDH
Contact information
Practice address
199 HWY 50, PECOS, NM 87552
(505) 757-6666
Mailing address
2 AVENIDA DE COMPADRES, SANTA FE, NM 87508-8713
(505) 757-6666
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH2815
NM
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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