Provider Demographics
NPI:1467537332
Name:FRAZIER, JOSEPH I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:I
Last Name:FRAZIER
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 1:7350 FOXFIRE DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1604
Mailing Address - Country:US
Mailing Address - Phone:815-459-5969
Mailing Address - Fax:
Practice Address - Street 1:690 N. ROUTE 31
Practice Address - Street 2:COLLEGE HILL PROFESSIONAL BUILDING
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012
Practice Address - Country:US
Practice Address - Phone:815-477-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19014301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist