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General NPI Number Information
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NPI Number | 1750669420
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Entity Type | Individual
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Provider Name | WAYNERD BERNARD FREDERICKSON II D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 6092 SE FEDERAL HWY
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City | STUART
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State | FL
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Zip | 34997-8101
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Country | US
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Telephone | 772-288-2345
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Fax | 844-269-6899
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Provider Business Mailing Address
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Address Line | 13809 IMPERIAL TOPAZ TRL
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2244
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Country | US
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Telephone | 630-418-1620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-028665
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN23167
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License Number State | FL
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