Provider Demographics
NPI:1457484230
Name:DREXLER, FREDERICK RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:RUSSELL
Last Name:DREXLER
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:PO BOX 446
Mailing Address - Street 2:303 5TH AVENUE
Mailing Address - City:CLARENCE
Mailing Address - State:IA
Mailing Address - Zip Code:52216-0446
Mailing Address - Country:US
Mailing Address - Phone:563-452-3794
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:IA
Practice Address - Zip Code:52216-0446
Practice Address - Country:US
Practice Address - Phone:563-452-3794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist