Provider Demographics
NPI:1598824385
Name:FRERICHS, CRAIG DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DONALD
Last Name:FRERICHS
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 1:5536 CHANTREY RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2029
Mailing Address - Country:US
Mailing Address - Phone:952-285-8085
Mailing Address - Fax:
Practice Address - Street 1:3000 N CHESTNUT ST
Practice Address - Street 2:#20
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-3054
Practice Address - Country:US
Practice Address - Phone:952-361-0777
Practice Address - Fax:952-361-6729
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice