Provider Demographics
NPI:1154632776
Name:PLATT, FREDRICK JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:JOSEPH
Last Name:PLATT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:FREDDY
Other - Middle Name:
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2020 LINDBERGH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1714
Mailing Address - Country:US
Mailing Address - Phone:903-592-7111
Mailing Address - Fax:
Practice Address - Street 1:2020 LINDBERGH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1714
Practice Address - Country:US
Practice Address - Phone:903-592-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX256701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies