Provider Demographics
NPI:1053321190
Name:FRAZIERO, RICHARD JOSEPH (DMD MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:FRAZIERO
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028
Mailing Address - Country:US
Mailing Address - Phone:413-525-0100
Mailing Address - Fax:413-525-8608
Practice Address - Street 1:382 NORTH MAIN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-525-0100
Practice Address - Fax:413-525-8608
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0166841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2244167Medicaid
X06153Medicare ID - Type Unspecified
MA2244167Medicaid