Provider Demographics
NPI:1225112535
Name:FRICHTER, BRYAN PRESTON (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:PRESTON
Last Name:FRICHTER
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 1:1230 S MORRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5702
Mailing Address - Country:US
Mailing Address - Phone:985-902-4477
Mailing Address - Fax:985-419-0018
Practice Address - Street 1:1230 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5702
Practice Address - Country:US
Practice Address - Phone:985-902-4477
Practice Address - Fax:985-419-0018
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA1929OtherBLUE CROSS DENTAL
LA1836834Medicaid
LA550794OtherUNITED CONCORDIA