Healthcare Provider Details

I. General information

NPI: 1427050608
Provider Name (Legal Business Name): WILLIAM JOSEPH FRERICKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MICHIGAN AVE STE 520
CHICAGO IL
60611-3755
US

IV. Provider business mailing address

500 N MICHIGAN AVE STE 520
CHICAGO IL
60611-3755
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-4424
  • Fax: 312-822-0877
Mailing address:
  • Phone: 312-337-4424
  • Fax: 312-822-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: