Provider Demographics
NPI:1861653172
Name:STRONER, FREDERICK M
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:STRONER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E WILLOW AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5445
Mailing Address - Country:US
Mailing Address - Phone:630-668-5285
Mailing Address - Fax:312-996-3535
Practice Address - Street 1:200 E WILLOW AVE STE 201
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5445
Practice Address - Country:US
Practice Address - Phone:630-668-5285
Practice Address - Fax:312-996-3535
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-020713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist