Provider Demographics
NPI:1346233707
Name:FROEHLICH, DEIRDRE LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:LEE
Last Name:FROEHLICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 NE WASCO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1772
Mailing Address - Country:US
Mailing Address - Phone:503-282-3884
Mailing Address - Fax:503-282-3893
Practice Address - Street 1:2824 NE WASCO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1772
Practice Address - Country:US
Practice Address - Phone:503-282-3884
Practice Address - Fax:503-282-3893
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
OR60651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice