Provider Demographics
NPI:1689075350
Name:WORRELL, FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:WORRELL
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 1:3625 148TH ST SW STE B101
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5577
Mailing Address - Country:US
Mailing Address - Phone:425-773-4909
Mailing Address - Fax:
Practice Address - Street 1:3625 148TH ST SW STE B101
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-5577
Practice Address - Country:US
Practice Address - Phone:425-773-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60238959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist