Provider Demographics
NPI:1417410952
Name:FRAZEY, AMY M (RDH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:FRAZEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 E HARMONY RD STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8816
Mailing Address - Country:US
Mailing Address - Phone:970-829-8209
Mailing Address - Fax:
Practice Address - Street 1:3541 E HARMONY RD STE 140
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8816
Practice Address - Country:US
Practice Address - Phone:970-829-8209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905802124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist