DR. GARY FREDERICKSON (NPI# 1043464068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043464068 |
| Entity Type | Individual |
| Full Name | DR. GARY FREDERICKSON |
| Credential | D.D.S. |
| Practice Address |
1313 Gilman St. #a Berkeley CA 94706 |
| Practice Telephone | 5105267546 |
| Practice Fax Number | 5105261027 |
| Mailing Telephone | 5105267546 |
| Mailing Fax Number | 5105261027 |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2008-11-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
18322 | CA | Dental Providers |
| Street Address |
1313 GILMAN ST. #A |
| City | BERKELEY |
| State | CA |
| Zip Code | 94706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295397065 | Cerrito Creek Family Medicine Inc | Family Medicine | 400 Evelyn Ave., St. 107, Albany, CA 94706 | 2019-07-02 |
| 1881250181 | Joan Marie Bernier | Speech-Language Pathologist | 622 Talbot Ave, Albany, CA 94706 | 2019-05-13 |
| 1528590064 | Priscila Lee | Dentist | 727 San Pablo Ave, Albany, CA 94706 | 2017-04-03 |
| 1316480130 | Junghi Lee | Acupuncturist | 411 Cornell Avenue Apt12, Albany, CA 94706 | 2016-11-28 |
| 1356702294 | Albany Physical Therapy A Professional Corporation | Physical Therapist | 948 San Pablo Avenue, Albany, CA 94706 | 2016-03-18 |
| 1437430592 | Olga Olina Rule | Marriage & Family Therapist | 828 San Pablo Ave., Ste 216 B, Albany, CA 94706 | 2011-09-02 |
| 1316246820 | Christine Gocke | Acupuncturist | 1285 Gilman St, Berkeley, CA 94706 | 2011-03-23 |
| 1750699393 | Barbara Helen Howell | Marriage & Family Therapist | 828 San Pablo Ave Ste 120a, Albany, CA 94706 | 2010-09-16 |
| 1225349954 | Shahin Tabibzadeh | Social Worker | 555 Pierce Street #704, Albany, CA 94706 | 2010-06-28 |
| 1215269089 | Ginny Howe | Chiropractor | 1500 Oak View Avenue, Kensington, CA 94706 | 2010-02-04 |
| Find all providers in zip 94706 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225388986 | Nga T Hoang | Dentist | 2640 Telegraph Ave Ste 201, Berkeley, CA 94704-3374 | 2012-09-10 |
| 1144436494 | P M Kasrovi Dds Ms A Prof Dental Corp | Dentist | 910 Ensenada Ave, Berkeley, CA 94705 | 2007-05-15 |
| 1275656191 | Natalia Vasylyk | Dentist | 2425 Channing Way # 201, Berkeley, CA 94704-2260 | 2007-04-07 |
| 1073593489 | Robert H. Iezman | Dentist | 1525 Walnut St, Berkeley, CA 94709-1512 | 2006-01-20 |
| 1639348659 | Raymond Michael Meyer | Dentist | 3010 Colby St, Berkeley, CA 94705-2092 | 2008-02-23 |
| 1841492584 | Robert H. Iezman, Dds and Seth R. Osterman, Dds | Dentist | 2999 Regent St, Suite 408, Berkeley, CA 94705-2146 | 2007-06-04 |
| 1275749590 | Paul Kasrovi Dds Ms A Professional Corporation | Dentist | 3010 Colby St, #220, Berkeley, CA 94705 | 2007-05-15 |
| 1740331289 | Angelica A Cabral | Dentist | 115 Berkeley Sq, Berkeley, CA 94704-1206 | 2007-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861091720 | Ellen Im Dds Inc | Dentist | 13422 Pomerado Rd Ste 201, Poway, CA 92064-3548 | 2020-10-21 |
| 1104425370 | Jack Bayraymyan Dental Group Inc. | Dentist | 2621 Zoe Ave Ste A, Huntington Park, CA 90255-4131 | 2020-10-20 |
| 1669071825 | Jack Bayraymyan Dental Group Inc. | Dentist | 418 E Glenoaks Blvd Ste 202, Glendale, CA 91207-2093 | 2020-10-20 |
| 1891394060 | Jack Bayraymyan Dental Group Inc. | Dentist | 600 S Alvarado St Ste 200-201, Los Angeles, CA 90057-3314 | 2020-10-20 |
| 1790391209 | Two Front Corp | Dentist | 2408 Grandview Ave, Venice, CA 90291-4938 | 2020-09-21 |
| 1396358453 | Bridget Powers | Dentist | 1000 Ygnacio Valley Rd, Walnut Creek, CA 94598-1812 | 2020-08-28 |
| 1144832221 | Manjeet Samra Dental Corporation | Dentist | 1700 Mchenry Ave Ste 16b, Modesto, CA 95350-4319 | 2020-08-19 |
| 1154932150 | Jacqueline Morgan Payne | Dentist | 1820 Sonoma Ave Ste 36, Santa Rosa, CA 95405-6617 | 2020-08-12 |
| 1922617802 | Andrew Levin | Dentist | 7891 Talbert Ave # 2, Huntington Beach, CA 92648-8612 | 2020-07-27 |
| 1861001885 | Robert Berger | Dentist | 2529 Via Sanchez, Palos Verdes Estates, CA 90274-2805 | 2020-07-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.