Healthcare Provider Details

I. General information

NPI: 1730128125
Provider Name (Legal Business Name): FRED S VIGDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 KENMORE BLVD
AKRON OH
44314
US

IV. Provider business mailing address

1003 KENMORE BLVD
AKRON OH
44314
US

V. Phone/Fax

Practice location:
  • Phone: 380-745-8895
  • Fax: 330-745-9782
Mailing address:
  • Phone: 380-745-8895
  • Fax: 330-745-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: