Provider Demographics
NPI:1710109988
Name:FRAZIER, JASON C (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 LEGACY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-6749
Mailing Address - Country:US
Mailing Address - Phone:214-618-6444
Mailing Address - Fax:214-889-8101
Practice Address - Street 1:9359 LEGACY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-6749
Practice Address - Country:US
Practice Address - Phone:214-618-6444
Practice Address - Fax:214-889-8101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182677801Medicaid
TX22679OtherCHIP NUMBER