Provider Demographics
NPI:1669683272
Name:FRASER, WILLIAM MARCUS (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARCUS
Last Name:FRASER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3262
Mailing Address - Country:US
Mailing Address - Phone:406-586-9725
Mailing Address - Fax:406-582-8159
Practice Address - Street 1:108 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3262
Practice Address - Country:US
Practice Address - Phone:406-586-9725
Practice Address - Fax:406-582-8159
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice