Daryl Frederick, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

10125 Issued in MI

Practice address

2641 Shirley Dr
Jackson, MI 49201-8633

Phone

(517) 787-5367

Fax

(517) 787-4219

NPI assigned

Nov 6, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Daryl W Frederick DDS PC

  • General Practice Dentistry
  • Jackson, MI
  • NPI 1942354725
  NPD (past) Authorized official
• Michigan Dentists PLLC

  • General Practice Dentistry
  • Jackson, MI
  • NPI 1376152504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383696000000",
    "number": "1033548474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2641 SHIRLEY DR",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492018633",
            "telephone_number": "517-787-5367",
            "fax_number": "517-787-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2641 SHIRLEY DR",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492018633",
            "telephone_number": "517-787-5367",
            "fax_number": "517-787-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "DARYL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-06",
        "last_updated": "2013-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "10125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Alyse Franklin, NP
• Phillip Frantzis, M.D.
• Kevin Franz, DMD
• Sara Fraser, RN
• Frederic B Slete D.D.S.,PC
• Alexis Nichole Freed, LLMSW
• Carla Renee Freeman, LLPC
• Daniel Paul Freeman, MD
• Kayla Freeman, LLMSW
• Kimberly Sue Freese-Beal, MD

• Dentist in Jackson, MI
• Providers in Jackson, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.