Provider Demographics
NPI:1225177033
Name:FRASER, BRUCE ALLEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:FRASER
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:463 WATERBURY CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-471-6600
Mailing Address - Fax:614-471-6660
Practice Address - Street 1:463 WATERBURY CT
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-471-6600
Practice Address - Fax:614-471-6660
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2017-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH300173401223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology