MEDICARE: WILLIAM J FRERICKS, DDS, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1790204386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM J FRERICKS, DDS, LTD

Provider Business Mailing Address
First Line	:	500 N MICHIGAN AVE STE 520
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3755
Country	:	US
Telephone Number	:	312-337-4424
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N MICHIGAN AVE STE 520
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3755
Country	:	US
Telephone Number	:	312-337-4424
Fax Number	:	312-822-0876

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM JOSEPH FRERICKS
Credential	:	DDS
Telephone Number	:	312-337-4424

Provider Enumeration Date	:	09/14/2017
Last Update Date	:	07/21/2022

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