Provider Demographics
NPI:1558446062
Name:LEWCOCK, FREDRICK ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:ROBERT
Last Name:LEWCOCK
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 1:119 E OLD SETTLERS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2211
Mailing Address - Country:US
Mailing Address - Phone:512-310-7303
Mailing Address - Fax:
Practice Address - Street 1:119 E OLD SETTLERS BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2211
Practice Address - Country:US
Practice Address - Phone:512-310-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty