Nicholas Anthony Fredericka, D.M.D
Individual provider Active NPI General Practice Dentistry · Yerington, NV
NPI 1790904589 · NPPES record last updated Jul 25, 2008
Key facts
- NPI
- 1790904589
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 30016140 (OH)
- Practice address
- 120 Bovard St
Yerington, NV 89447-2437 - Phone
- (775) 463-1800
- Fax
- (775) 463-4810
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30016140 | OH | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nicholas a. Fredericka D.M.D. Inc. | General Practice | Past | Accepting new patients |
| Healthy Smiles Family Dentistry Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30016140 | OH | Yes |
Addresses
Primary practice location
120 Bovard St
Yerington, NV 89447-2437
Mailing address
120 Bovard St
Yerington, NV 89447-2437
Phone (775) 463-1800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0493729 | Medicaid | OH | |
| 341352009027 | Medicaid | OH | |
| 196764 | Other | OH | UNITED CONCORDIA INS. ID# |
| 341352009 | Other | OH | DELTA DENTAL INS PROV. ID |
Other providers in Yerington, NV
- Skye Evans
- Randie C Farmer
- Glenn Fens
- Zachary Fodge
- Edward Folwick
- Chasity Ann Ganimian
- Carrie Lee Gilmore
- Ryan Gilmore
- Nancy Gilson-Lucier
- Robert Glass
All providers in Yerington, NV · General Practice Dentistry in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2008. 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.