Provider Demographics
NPI:1306856661
Name:KECK, FRAZIER SCHORR (DDS)
Entity Type:Individual
Prefix:
First Name:FRAZIER
Middle Name:SCHORR
Last Name:KECK
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 1:2900 CROASDAILE DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-383-7402
Mailing Address - Fax:919-383-3755
Practice Address - Street 1:2900 CROASDAILE DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-383-7402
Practice Address - Fax:919-383-3755
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice