Provider Demographics
NPI:1558301747
Name:FRER, ANTHONY ADAM (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ADAM
Last Name:FRER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2309
Mailing Address - Country:US
Mailing Address - Phone:773-229-1100
Mailing Address - Fax:773-229-1446
Practice Address - Street 1:6715 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2309
Practice Address - Country:US
Practice Address - Phone:773-229-1100
Practice Address - Fax:773-229-1446
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204754Medicare ID - Type Unspecified
ILT37121Medicare UPIN