Provider Demographics
NPI:1417098047
Name:FRAZIER, CAROL E (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DOWLING AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1433
Mailing Address - Country:US
Mailing Address - Phone:609-413-4058
Mailing Address - Fax:
Practice Address - Street 1:2327 COTTMAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1008
Practice Address - Country:US
Practice Address - Phone:215-332-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02166300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0026352Medicaid