Individual
DR. KNUTE A FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7600 SE DIVISION ST, PORTLAND, OR 97206-1058
(503) 774-3033
Mailing address
7600 SE DIVISION ST, PORTLAND, OR 97206-1058
(503) 774-3033
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5170
OR
Other
Enumeration date
08/05/2006
Last updated
07/08/2007
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