Lisa Fredrickson

NPI #1023576493 in Windsor, Connecticut

Provider Information

NPI Number: 1023576493
Entity Type: Individual
Name: Lisa Fredrickson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 5, 2019
Last Updated: Aug 20, 2020

Practice Location

Address: 250 LAMBERTON RD
City: Windsor
State: Connecticut
ZIP Code: 06095-2149
Phone: (860) 688-3663

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary
Student in an Organized Health Care Education/Training Program	390200000X

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