Provider Demographics
NPI:1376711580
Name:FREDERICK, ANNA GIRARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:GIRARD
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 COCHRANE CIR BLDG 7495US
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:719-526-5551
Practice Address - Street 1:1667 COCHRANE CIR BLDG 7495US
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-646-6009
Practice Address - Fax:719-526-5551
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87811223G0001X
CO101141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice