Provider Demographics
NPI:1386654465
Name:WILBUR, FREDERICK PRINCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:PRINCE
Last Name:WILBUR
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 1:11851 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2338
Mailing Address - Country:US
Mailing Address - Phone:512-258-4144
Mailing Address - Fax:512-335-1258
Practice Address - Street 1:11851 JOLLYVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2338
Practice Address - Country:US
Practice Address - Phone:512-258-4144
Practice Address - Fax:512-335-1258
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice