Healthcare Provider Details

I. General information

NPI: 1922249655
Provider Name (Legal Business Name): JULIA NANCY FREDERICKS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LENORA ST STE 216
SEATTLE WA
98121-2753
US

IV. Provider business mailing address

34617 11TH AVE S STE 102
FEDERAL WAY WA
98003-8706
US

V. Phone/Fax

Practice location:
  • Phone: 206-402-5490
  • Fax:
Mailing address:
  • Phone: 253-838-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60116120
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: