Provider Demographics
NPI:1487674966
Name:CHITTENDEN, FRED C (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:CHITTENDEN
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 1:2012 GRADE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9135
Mailing Address - Country:US
Mailing Address - Phone:425-334-1934
Mailing Address - Fax:
Practice Address - Street 1:2012 GRADE RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9135
Practice Address - Country:US
Practice Address - Phone:425-334-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist