Provider Demographics
NPI:1710937503
Name:FREDERICK, EDWARD FRANCIS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRANCIS
Last Name:FREDERICK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20 TREMONT ST
Mailing Address - Street 2:SUITE 34
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-5310
Mailing Address - Country:US
Mailing Address - Phone:781-934-0022
Mailing Address - Fax:781-934-0080
Practice Address - Street 1:20 TREMONT ST
Practice Address - Street 2:SUITE 34
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5310
Practice Address - Country:US
Practice Address - Phone:781-934-0022
Practice Address - Fax:781-934-0080
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA14316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist