Provider Demographics
NPI:1093789331
Name:AUSTERMANN, FREDRICK C (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:C
Last Name:AUSTERMANN
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 1:6217 S PACKARD AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3096
Mailing Address - Country:US
Mailing Address - Phone:414-764-5550
Mailing Address - Fax:414-764-8175
Practice Address - Street 1:6217 S PACKARD AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-3096
Practice Address - Country:US
Practice Address - Phone:414-764-5550
Practice Address - Fax:414-764-8175
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50004961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33535800Medicaid