Provider Demographics
NPI:1578243002
Name:FREDRICKSON, JULIA P (DDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:P
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16125 JUANITA WOODINVILLE WAY NE UNIT 1504
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9437
Mailing Address - Country:US
Mailing Address - Phone:206-734-8090
Mailing Address - Fax:
Practice Address - Street 1:19115 112TH AVE NE STE B101
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-0043
Practice Address - Country:US
Practice Address - Phone:425-492-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61453969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist