Provider Demographics
NPI:1114046976
Name:MARTIN J FRASCHETTI, D.D.S., FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:MARTIN J FRASCHETTI, D.D.S., FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRASCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FICCMO
Authorized Official - Phone:586-773-1212
Mailing Address - Street 1:27731 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1309
Mailing Address - Country:US
Mailing Address - Phone:586-773-1212
Mailing Address - Fax:586-778-5756
Practice Address - Street 1:27731 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1309
Practice Address - Country:US
Practice Address - Phone:586-773-1212
Practice Address - Fax:586-778-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0137411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty