Provider Demographics
NPI:1477808707
Name:FRYE, JOSHUA RYAN (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
Last Name:FRYE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25515 GLENBURN RD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER MILLS
Mailing Address - State:CA
Mailing Address - Zip Code:96028-9710
Mailing Address - Country:US
Mailing Address - Phone:814-777-7861
Mailing Address - Fax:
Practice Address - Street 1:554-850 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIEBER
Practice Address - State:CA
Practice Address - Zip Code:96009-8000
Practice Address - Country:US
Practice Address - Phone:309-999-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1036951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice