Organization
DARYL W FREDERICK DDS PC
Active
Other names
JACKSON CENTER FOR COSMETIC AND RESTORATIVE DENTISTRY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARYL WILLIAM FREDERICK D.D.S. (OWNER)
(517) 787-5367
Entity
Organization
Contact information
Practice address
2641 SHIRLEY DR, JACKSON, MI 49201-8633
(517) 787-5367
(517) 787-4219
Mailing address
2641 SHIRLEY DR, JACKSON, MI 49201-8633
(517) 787-5367
(517) 787-4219
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10125
MI
Other
Enumeration date
01/22/2007
Last updated
08/22/2020
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