Provider Demographics
NPI:1003897190
Name:FREDERICK, DANIEL FRANK
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FRANK
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:FRANK
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1514 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4825
Mailing Address - Country:US
Mailing Address - Phone:931-381-7591
Mailing Address - Fax:
Practice Address - Street 1:1514 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4825
Practice Address - Country:US
Practice Address - Phone:931-381-7591
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN#40591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
65978OtherMET LIFE
CBTN1OtherBCBS TENNESSEE
52133OtherUNITED HEALTH CARE
62308OtherCIGNA
80705OtherGREAT WEST
CDMIOOtherDELTA MICHIGAN
60054OtherAETNA
67814OtherGE FINANCIAL
87726OtherCIGNA (CRACKER BARREL)
CDTN1OtherDELTA TENNESSEE
10050OtherCIGNA ( RUBY TUESDAY)
47009OtherAMERITUS
58066OtherAFLAC
61271OtherPRINCIPAL
70408OtherFORTIS
84056OtherDELTA COLORADO
94276OtherDELTA GEORGIA
CDAR1OtherDELTA ARKANSAS
CDMN1OtherDELTA MINNESOTA