Provider Demographics
NPI:1508083668
Name:FRAWLEY, KEVIN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:FRAWLEY
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 1:11025 FULLBRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1710
Mailing Address - Country:US
Mailing Address - Phone:310-652-8383
Mailing Address - Fax:310-652-5467
Practice Address - Street 1:8920 WILSHIRE BLVD STE 701
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2006
Practice Address - Country:US
Practice Address - Phone:310-652-8383
Practice Address - Fax:310-652-5467
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice