Provider Demographics
NPI:1992496467
Name:FREDETTE, KIANA
Entity type:Individual
Prefix:DR
First Name:KIANA
Middle Name:
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N PRECINCT ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02718-1516
Mailing Address - Country:US
Mailing Address - Phone:774-218-1171
Mailing Address - Fax:
Practice Address - Street 1:336 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-2136
Practice Address - Country:US
Practice Address - Phone:508-802-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist