Provider Demographics
NPI:1477601078
Name:SOLDAU, FREDERICK U (DDD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:U
Last Name:SOLDAU
Suffix:
Gender:M
Credentials:DDD
Other - Prefix:DR
Other - First Name:FREDERICK
Other - Middle Name:U
Other - Last Name:SOLDAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:850 PROSPECT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4208
Mailing Address - Country:US
Mailing Address - Phone:858-454-6124
Mailing Address - Fax:858-459-8908
Practice Address - Street 1:850 PROSPECT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4208
Practice Address - Country:US
Practice Address - Phone:858-454-6124
Practice Address - Fax:858-459-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice