Provider Demographics
NPI:1194017699
Name:FRAZIER, ZACHARY T (DDS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:T
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 LARRY POWER RD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4430
Mailing Address - Country:US
Mailing Address - Phone:815-802-1217
Mailing Address - Fax:
Practice Address - Street 1:376 LARRY POWER RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4430
Practice Address - Country:US
Practice Address - Phone:815-802-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0025211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics