Individual
DOUGLAS NORMAN DEDERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, PHD
Contact information
Practice address
500 W SILVER SPRING DR STE K250, GLENDALE, WI 53217-5062
(414) 963-2301
Mailing address
6330 W GREENFIELD AVE APT 408, MILWAUKEE, WI 53214-5073
(780) 868-1562
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3322-15
WI
Other
Enumeration date
05/25/2024
Last updated
05/25/2024
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