Provider Demographics
NPI:1174866651
Name:BEGEMAN, FREDERICK DOUGLAS (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:DOUGLAS
Last Name:BEGEMAN
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 1:315 ALHAMBRA CIR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5003
Mailing Address - Country:US
Mailing Address - Phone:305-441-8587
Mailing Address - Fax:305-441-2610
Practice Address - Street 1:315 ALHAMBRA CIR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5003
Practice Address - Country:US
Practice Address - Phone:305-441-8587
Practice Address - Fax:305-441-2610
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice