Provider Demographics
NPI:1881950053
Name:FREDERICK, BIANCA MAUREEN (DDS)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:MAUREEN
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13314 TOPPLING LN
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5484
Mailing Address - Country:US
Mailing Address - Phone:228-257-3911
Mailing Address - Fax:228-257-3911
Practice Address - Street 1:9226 POTRANCO RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2277
Practice Address - Country:US
Practice Address - Phone:210-674-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0570781223X0400X
TX322931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics