Provider Demographics
NPI:1558854398
Name:KATHERINE L. FRY DMD PC
Entity Type:Organization
Organization Name:KATHERINE L. FRY DMD PC
Other - Org Name:VININGS ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:FRY
Authorized Official - Last Name:HIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-901-4585
Mailing Address - Street 1:1387 PIERCE AVE SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2148
Mailing Address - Country:US
Mailing Address - Phone:678-990-3363
Mailing Address - Fax:678-401-2298
Practice Address - Street 1:3065 AKERS MILL RD SE STE 225
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3124
Practice Address - Country:US
Practice Address - Phone:678-990-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13702OtherLICENSE NUMBER
1427247402OtherNPI INDIVIDUAL
AL5473OtherLICENSE NUMBER