Provider Demographics
NPI:1568660363
Name:CHUCKOVICH, FREDRIC DUKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:DUKE
Last Name:CHUCKOVICH
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 1:4211 WAIALAE AVE
Mailing Address - Street 2:ST 500
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-735-3455
Mailing Address - Fax:808-737-4433
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:ST 500
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-735-3455
Practice Address - Fax:808-737-4433
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist