Provider Demographics
NPI:1568002954
Name:FRERICHS AND DAVIDSON PLLC
Entity Type:Organization
Organization Name:FRERICHS AND DAVIDSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-424-3611
Mailing Address - Street 1:206 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4507
Mailing Address - Country:US
Mailing Address - Phone:360-424-3611
Mailing Address - Fax:360-424-3300
Practice Address - Street 1:206 S 15TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4507
Practice Address - Country:US
Practice Address - Phone:360-424-3611
Practice Address - Fax:360-424-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487884086OtherDENTAL PROVIDER
WA1134518293OtherDENTAL PROVIDER