Provider Demographics
NPI:1689709826
Name:CLASQUIN, FREDERICK HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:HENRY
Last Name:CLASQUIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 WILLOWBROOKE DR.
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420
Mailing Address - Country:US
Mailing Address - Phone:585-637-4430
Mailing Address - Fax:
Practice Address - Street 1:56 MARKET ST
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1934
Practice Address - Country:US
Practice Address - Phone:585-637-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist