Provider Demographics
NPI:1083136568
Name:DR. DOUGLAS S. FRY DDS PLLC
Entity Type:Organization
Organization Name:DR. DOUGLAS S. FRY DDS PLLC
Other - Org Name:SUNSHINE CHILDREN'S DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-762-7736
Mailing Address - Street 1:1911 S 17TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6662
Mailing Address - Country:US
Mailing Address - Phone:910-762-7736
Mailing Address - Fax:910-251-8845
Practice Address - Street 1:1911 S 17TH ST STE 140
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6662
Practice Address - Country:US
Practice Address - Phone:910-762-7736
Practice Address - Fax:910-251-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200002701036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty