Provider Demographics
NPI:1235272089
Name:ELSAESSER, FREDERICK JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JAMES
Last Name:ELSAESSER
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 1:84 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2015
Mailing Address - Country:US
Mailing Address - Phone:207-725-5831
Mailing Address - Fax:
Practice Address - Street 1:84 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2015
Practice Address - Country:US
Practice Address - Phone:207-725-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME28081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice