Provider Demographics
NPI:1114418027
Name:FRYE, BEVERLY SUE
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:SUE
Last Name:FRYE
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 1:2106 E PHINNEY BAY DR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2732
Mailing Address - Country:US
Mailing Address - Phone:360-689-2087
Mailing Address - Fax:
Practice Address - Street 1:2106 E PHINNEY BAY DR
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2732
Practice Address - Country:US
Practice Address - Phone:360-689-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006727124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist