Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS021600L | PA |
NPI | 1063437549 |
---|---|
Provider Name | Dr. Stuart M Fredd |
First Address | Lansdale, PA 19446 |
Second Address | Lansdale, PA 19446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T29717 | (02) |