Provider Demographics
NPI:1003006750
Name:KANE, FREDERICK (DMD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:KANE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11634 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1005
Mailing Address - Country:US
Mailing Address - Phone:305-270-2020
Mailing Address - Fax:305-270-2097
Practice Address - Street 1:11634 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1005
Practice Address - Country:US
Practice Address - Phone:305-270-2020
Practice Address - Fax:305-270-2097
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist