Provider Demographics
NPI:1790204386
Name:WILLIAM J FRERICKS, DDS, LTD
Entity Type:Organization
Organization Name:WILLIAM J FRERICKS, DDS, LTD
Other - Org Name:THE MAGNIFICENT SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FRERICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-337-4424
Mailing Address - Street 1:500 N MICHIGAN AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3755
Mailing Address - Country:US
Mailing Address - Phone:312-337-4424
Mailing Address - Fax:
Practice Address - Street 1:500 N MICHIGAN AVE STE 520
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3755
Practice Address - Country:US
Practice Address - Phone:312-337-4424
Practice Address - Fax:312-822-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty