Provider Demographics
NPI:1487757076
Name:NEDOCK, FRANK WILSON (DDS)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:WILSON
Last Name:NEDOCK
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 1:10641 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2147
Mailing Address - Country:US
Mailing Address - Phone:248-698-2880
Mailing Address - Fax:
Practice Address - Street 1:10641 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2147
Practice Address - Country:US
Practice Address - Phone:248-698-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010109481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4543970Medicaid