Provider Demographics
NPI:1740400084
Name:DONIKOWSKI, FREDERICK PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:PAUL
Last Name:DONIKOWSKI
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 1:1615 VALHALLA CT
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-1779
Mailing Address - Country:US
Mailing Address - Phone:540-389-7772
Mailing Address - Fax:
Practice Address - Street 1:230 MARKET ST.
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:VA
Practice Address - Zip Code:24127
Practice Address - Country:US
Practice Address - Phone:540-864-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010048331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice