Provider Demographics
NPI:1669582524
Name:MCCREADY, FREDERICK JOSEPH JR (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:MCCREADY
Suffix:JR
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 1:255 PARK AVENUE
Mailing Address - Street 2:SUITE 804
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1984
Mailing Address - Country:US
Mailing Address - Phone:508-757-3466
Mailing Address - Fax:508-459-5277
Practice Address - Street 1:255 PARK AVENUE
Practice Address - Street 2:SUITE 804
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1984
Practice Address - Country:US
Practice Address - Phone:508-757-3466
Practice Address - Fax:508-459-5277
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA128981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice