Provider Demographics
NPI:1477048759
Name:FRY, MATTHEW S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:FRY
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 1:550 28TH ST SE APT 204
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6849
Mailing Address - Country:US
Mailing Address - Phone:620-757-3677
Mailing Address - Fax:
Practice Address - Street 1:431 MAIN ST N STE B
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1172
Practice Address - Country:US
Practice Address - Phone:507-867-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice