Individual
DANIEL AARON FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
34800 BOB WILSON DR, NMCSD, SAN DIEGO, CA 92134-1098
(503) 467-8895
Mailing address
3877 PELL PL, #322, SAN DIEGO, CA 92130-4143
(503) 467-8895
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9174
OR
Other
Enumeration date
09/03/2008
Last updated
09/03/2008
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