Provider Demographics
NPI:1831311802
Name:GRASSIN, FREDERICK JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JOHN
Last Name:GRASSIN
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 1:5347 MAIN STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652
Mailing Address - Country:US
Mailing Address - Phone:727-841-9800
Mailing Address - Fax:727-848-4768
Practice Address - Street 1:5347 MAIN STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652
Practice Address - Country:US
Practice Address - Phone:727-841-9800
Practice Address - Fax:727-848-4768
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics