Provider Demographics
NPI:1902019326
Name:ANDERSON, FREDERICK DAMIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:DAMIAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16737 FISHHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3860
Mailing Address - Country:US
Mailing Address - Phone:813-662-7171
Mailing Address - Fax:813-662-3024
Practice Address - Street 1:16737 FISHHAWK BLVD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3860
Practice Address - Country:US
Practice Address - Phone:813-662-7171
Practice Address - Fax:813-662-3024
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist