Provider Demographics
NPI:1619184439
Name:FRATT DENTAL CORPORATION
Entity Type:Organization
Organization Name:FRATT DENTAL CORPORATION
Other - Org Name:WEST COVINA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-428-1200
Mailing Address - Street 1:1400 W WEST COVINA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2731
Mailing Address - Country:US
Mailing Address - Phone:626-338-4848
Mailing Address - Fax:
Practice Address - Street 1:1400 W WEST COVINA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2731
Practice Address - Country:US
Practice Address - Phone:626-338-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty