Provider Demographics
NPI:1689659328
Name:FREDERICK, RORY BARTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:BARTON
Last Name:FREDERICK
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:PO BOX 2326
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-2326
Mailing Address - Country:US
Mailing Address - Phone:803-316-6859
Mailing Address - Fax:
Practice Address - Street 1:21 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-9054
Practice Address - Country:US
Practice Address - Phone:828-479-7901
Practice Address - Fax:828-479-7902
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87431223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health