Provider Demographics
NPI:1770660946
Name:FREDERICK C. PREHN SOLE PROP
Entity Type:Organization
Organization Name:FREDERICK C. PREHN SOLE PROP
Other - Org Name:PREHN DENTAL OFFICE, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER OF PREHEN DENTAL OFFICE
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:PREHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-842-1270
Mailing Address - Street 1:413 JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:715-842-1270
Mailing Address - Fax:715-848-2906
Practice Address - Street 1:413 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:715-842-1270
Practice Address - Fax:715-848-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29300151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty