Provider Demographics
NPI:1023202934
Name:FREDRICK, JOHN ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:FREDRICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:E
Other - Last Name:FREDRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6151 N FRESNO ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8613
Mailing Address - Country:US
Mailing Address - Phone:559-438-0121
Mailing Address - Fax:559-432-1059
Practice Address - Street 1:6151 N FRESNO ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8613
Practice Address - Country:US
Practice Address - Phone:559-438-0121
Practice Address - Fax:559-432-1059
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist