Provider Demographics
NPI:1598793887
Name:FRAZIER, ROBERT DURAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DURAND
Last Name:FRAZIER
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 1:5538 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3062
Mailing Address - Country:US
Mailing Address - Phone:937-277-9387
Mailing Address - Fax:937-277-9388
Practice Address - Street 1:5538 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3062
Practice Address - Country:US
Practice Address - Phone:937-277-9387
Practice Address - Fax:937-277-9388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2351959Medicaid
OH2351959Medicaid