Donald Vincent Fregeau Jr., DDS
Individual provider Active NPI Dentist · Fortuna, CA
NPI 1306866975 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1306866975
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D27519 (CA)
- Practice address
- 569 S Fortuna Blvd
Fortuna, CA 95540-3002 - Phone
- (707) 725-4419
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D27519 | CA | MD | Dentist |
| 27519 | CA | MD | Certified Respiratory Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D27519 | CA | Yes |
Addresses
Primary practice location
569 S Fortuna Blvd
Fortuna, CA 95540-3002
Mailing address
569 S Fortuna Blvd
Fortuna, CA 95540-3002
Phone (707) 725-4419
Other providers in Fortuna, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.