Provider Demographics
NPI:1306990882
Name:ROHWEDDER, FREDERICK WAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:WAYNE
Last Name:ROHWEDDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WEST ST RT 67
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2650
Mailing Address - Country:US
Mailing Address - Phone:203-888-4561
Mailing Address - Fax:203-888-9847
Practice Address - Street 1:245 WEST ST RT 67
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2650
Practice Address - Country:US
Practice Address - Phone:203-888-4561
Practice Address - Fax:203-888-9847
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT47201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice