Provider Demographics
NPI:1306824073
Name:FREDERICK, RICHARD STEVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEVEN
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 RIVERBEND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-2556
Mailing Address - Country:US
Mailing Address - Phone:256-546-9214
Mailing Address - Fax:256-546-0564
Practice Address - Street 1:819 RIVERBEND DR
Practice Address - Street 2:SUITE B
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-2556
Practice Address - Country:US
Practice Address - Phone:256-546-9214
Practice Address - Fax:256-546-0564
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL92286OtherBLUE CROSS BLUE SHIELD