Provider Demographics
NPI:1003942079
Name:WASSERMANN, FREDERICK HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:HOWARD
Last Name:WASSERMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27620 FARMINGTON ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-489-0899
Mailing Address - Fax:248-489-1056
Practice Address - Street 1:27620 FARMINGTON ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-489-0899
Practice Address - Fax:248-489-1056
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901008717122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice