Provider Demographics
NPI:1558485805
Name:WALTER J FRAZEE DDS PA
Entity Type:Organization
Organization Name:WALTER J FRAZEE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FRAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-623-1000
Mailing Address - Street 1:807 WEST GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-623-1000
Mailing Address - Fax:501-623-1506
Practice Address - Street 1:807 WEST GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-623-1000
Practice Address - Fax:501-623-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty