Provider Demographics
NPI:1689609034
Name:FRAZEE, TROY A (MD DDS)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:FRAZEE
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-845-0555
Mailing Address - Fax:440-845-4556
Practice Address - Street 1:7232 PEARL RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-845-0555
Practice Address - Fax:440-845-4556
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300199421223S0112X
OH35080359204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080975Medicaid
H52635Medicare UPIN
N09298771Medicare ID - Type Unspecified