Provider Demographics
NPI:1972801934
Name:PREHN, FREDERICK C (DDS)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:PREHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5433
Mailing Address - Country:US
Mailing Address - Phone:715-842-1270
Mailing Address - Fax:715-848-2906
Practice Address - Street 1:413 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5433
Practice Address - Country:US
Practice Address - Phone:715-842-1270
Practice Address - Fax:715-848-2906
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770660946OtherBUSINESS NPI NUMBER