NPIMap

Organization Active NPI

Daryl W Frederick DDS PC

  • General Practice Dentistry
  • Jackson, MI
National Provider Identifier
1942354725
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10125 Issued in MI
Legal business name
DARYL W FREDERICK DDS PC
Doing business as
JACKSON CENTER FOR COSMETIC AND RESTORATIVE DENTISTRY
Practice address
2641 Shirley Dr
Jackson, MI 49201-8633
Phone
(517) 787-5367
Fax
(517) 787-4219
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Daryl William Frederick, D.D.S.NPI 1033548474
Title
Owner
Phone
(517) 787-5367

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10125 MI Primary

Addresses

Primary practice location

2641 Shirley Dr
Jackson, MI 49201-8633

Mailing address

2641 Shirley Dr
Jackson, MI 49201-8633
Phone (517) 787-5367

Other names 1

  • JACKSON CENTER FOR COSMETIC AND RESTORATIVE DENTISTRY Doing business as

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942354725",
    "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": {
        "organization_name": "DARYL W FREDERICK DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "DARYL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-787-5367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "10125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON CENTER FOR COSMETIC AND RESTORATIVE DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.