Provider Demographics
NPI:1457649675
Name:FRANDSEN FAMILY DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:FRANDSEN FAMILY DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-884-3476
Mailing Address - Street 1:14 N HALE ST
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-9315
Mailing Address - Country:US
Mailing Address - Phone:435-884-3476
Mailing Address - Fax:435-884-6790
Practice Address - Street 1:14 N HALE ST
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029
Practice Address - Country:US
Practice Address - Phone:435-884-3002
Practice Address - Fax:435-884-6790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANDSEN FAMILY DENTAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5125133-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5224323622001Medicaid