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General NPI Number Information
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NPI Number | 1326785106
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Entity Type | Organization
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Legal Business Name | FREDERICK CLASQUIN DMD P.C.
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Dates
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Enumeration Date | 05/13/2022
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 56 MARKET ST
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City | BROCKPORT
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State | NY
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Zip | 14420-1934
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Country | US
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Telephone | 585-637-4430
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Fax | 585-637-4603
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Provider Business Mailing Address
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Address Line | 56 MARKET ST
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City | BROCKPORT
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State | NY
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Zip | 14420-1934
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Country | US
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Telephone | 585-637-4430
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Fax | 585-637-4603
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. FREDERICK HENRY CLASQUIN
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Credential | DMD
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Telephone | 585-637-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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