Provider Demographics
NPI:1942335153
Name:FREDERICK, BRIAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:FREDERICK
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 1:411 W OJAI AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2443
Mailing Address - Country:US
Mailing Address - Phone:805-669-6700
Mailing Address - Fax:805-640-1599
Practice Address - Street 1:411 W OJAI AVE STE C
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2443
Practice Address - Country:US
Practice Address - Phone:805-669-6700
Practice Address - Fax:805-640-1599
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice