Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901008717 | MI |
N | 1223G0001X | General Practice | 2901008717 | MI |
N | 213EG0000X | General Practice | 2901008717 | MI |
NPI | 1003942079 |
---|---|
Provider Name | Dr. Frederick Howard Wassermann |
First Address | Farmington Hills, MI 48334 |
Second Address | Farmington Hills, MI 48334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |