Provider Demographics
NPI:1164710562
Name:FRAGALE, ERNEST STEPHEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:STEPHEN
Last Name:FRAGALE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CAPITOL ST STE 914
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1744
Mailing Address - Country:US
Mailing Address - Phone:304-345-1248
Mailing Address - Fax:304-345-1249
Practice Address - Street 1:405 CAPITOL ST STE 914
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1744
Practice Address - Country:US
Practice Address - Phone:304-345-1248
Practice Address - Fax:304-345-1249
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39351223E0200X
SC71351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223E0200XDental ProvidersDentistEndodontics