Provider Demographics
NPI:1679656789
Name:KAMANSKY, FRED W (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:W
Last Name:KAMANSKY
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 1:6529 MISSION GORGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2376
Mailing Address - Country:US
Mailing Address - Phone:619-280-8377
Mailing Address - Fax:619-280-8378
Practice Address - Street 1:6529 MISSION GORGE ROAD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2376
Practice Address - Country:US
Practice Address - Phone:619-280-8377
Practice Address - Fax:619-280-8378
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics