Provider Demographics
NPI:1669819462
Name:FEDORE, CLAIRE WOOD (DDS)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:WOOD
Last Name:FEDORE
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 1:4615 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9307
Mailing Address - Country:US
Mailing Address - Phone:517-881-8488
Mailing Address - Fax:
Practice Address - Street 1:714 ABBOT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3101
Practice Address - Country:US
Practice Address - Phone:517-337-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist