Provider Demographics
NPI:1124558853
Name:FRUGOLI, STEPHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:FRUGOLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-7458
Mailing Address - Country:US
Mailing Address - Phone:775-246-7122
Mailing Address - Fax:
Practice Address - Street 1:901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-7458
Practice Address - Country:US
Practice Address - Phone:775-246-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV69331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice