Provider Demographics
NPI:1659447183
Name:FROMM, WILFRED FREDRICK (DDS)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:FREDRICK
Last Name:FROMM
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 1:29010 CHARDON ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092
Mailing Address - Country:US
Mailing Address - Phone:440-944-2200
Mailing Address - Fax:440-944-2202
Practice Address - Street 1:29010 CHARDON ROAD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092
Practice Address - Country:US
Practice Address - Phone:440-944-2200
Practice Address - Fax:440-944-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186311223G0001X
OH300186311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice