Provider Demographics
NPI:1689715559
Name:HECHT, FREDRICK LOUIS III (DMD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:LOUIS
Last Name:HECHT
Suffix:III
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 1:127 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8131
Mailing Address - Country:US
Mailing Address - Phone:717-530-1120
Mailing Address - Fax:717-249-9060
Practice Address - Street 1:127 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8131
Practice Address - Country:US
Practice Address - Phone:717-530-1120
Practice Address - Fax:717-530-5184
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017915L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005325670002Medicaid
PAT71897Medicare UPIN
100669FLMMedicare ID - Type Unspecified