NPIMap

Organization Active NPI

Robert Herbert Fredrickson

  • Dentist
  • Williamsport, PA
National Provider Identifier
1386020170
Registry record updated Nov 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS017415L Issued in PA
Legal business name
ROBERT HERBERT FREDRICKSON
Practice address
1124 Market St
Williamsport, PA 17701-2124
Phone
(570) 326-6170
NPI assigned
Aug 4, 2015
Last updated
Nov 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2015

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

Authorized official

Name
Robert H Fredrickson, DDSNPI 1508907809
Title
Owner
Phone
(570) 326-6170

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DS017415L PA Primary

Addresses

Primary practice location

1124 Market St
Williamsport, PA 17701-2124

Mailing address

1124 Market St
Williamsport, PA 17701-2124
Phone (570) 326-6170

Other names 1

  • ROBERT H FREDRICKSON DDS Other name

National Provider Directory

National Provider Directory

Locations

1124 Market St
Williamsport, PA 17701
Phone (570) 326-6170

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446422400000",
    "number": "1386020170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 MARKET ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177012124",
            "telephone_number": "570-326-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 MARKET ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177012124",
            "telephone_number": "570-326-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT HERBERT FREDRICKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-04",
        "last_updated": "2015-11-02",
        "status": "A",
        "authorized_official_last_name": "FREDRICKSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-326-6170",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS017415L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROBERT H FREDRICKSON DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.