Provider Demographics
NPI:1346270105
Name:FRICKE, ROBERT R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:FRICKE
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 1:827 ALTOS OAKS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5490
Mailing Address - Country:US
Mailing Address - Phone:650-941-1499
Mailing Address - Fax:650-941-1416
Practice Address - Street 1:827 ALTOS OAKS DR STE 1
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5490
Practice Address - Country:US
Practice Address - Phone:650-941-1499
Practice Address - Fax:650-941-1416
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice