NPIMap

Organization Active NPI

Fredrick W Wicknick DMD Inc PS

  • Oral and Maxillofacial Surgery (Dentist)
  • Bellingham, WA
National Provider Identifier
1659592103
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DE00006347 Issued in WA
Legal business name
FREDRICK W WICKNICK DMD INC PS
Practice address
3136 Squalicum Pkwy
Suite #B
Bellingham, WA 98225-1954
Phone
(360) 671-4859
Fax
(360) 671-3010
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Dr. Fredrick W Wicknick, DMD
Title
President
Phone
(360) 671-4859

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X DE00006347 WA Primary

Addresses

Primary practice location

3136 Squalicum Pkwy
Suite #B
Bellingham, WA 98225-1954

Mailing address

3136 Squalicum Pkwy
Suite #B
Bellingham, WA 98225-1954
Phone (360) 671-4859

Other identifiers 2

IdentifierTypeStateIssuer
08367OtherWAWDS
581903OtherWAUNITED CONCORDIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1659592103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3136 SQUALICUM PKWY",
            "address_2": "SUITE #B",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251954",
            "telephone_number": "360-671-4859",
            "fax_number": "360-671-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3136 SQUALICUM PKWY",
            "address_2": "SUITE #B",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251954",
            "telephone_number": "360-671-4859",
            "fax_number": "360-671-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDRICK W WICKNICK DMD INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "WICKNICK",
        "authorized_official_first_name": "FREDRICK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-671-4859",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00006347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WDS",
            "identifier": "08367",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "581903",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellingham, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; 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.