Provider Demographics
NPI:1477876076
Name:FREDRIKSON, DEBRA JO (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JO
Last Name:FREDRIKSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 SE 33RD PL
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3007
Mailing Address - Country:US
Mailing Address - Phone:206-948-7355
Mailing Address - Fax:
Practice Address - Street 1:8413 SE 33RD PL
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3007
Practice Address - Country:US
Practice Address - Phone:206-948-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005314124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist