Provider Demographics
NPI:1720578669
Name:FRYE, NATHANIEL DAVID (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DAVID
Last Name:FRYE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3760
Mailing Address - Country:US
Mailing Address - Phone:814-758-0476
Mailing Address - Fax:
Practice Address - Street 1:3075 SMITH RD STE 201
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4454
Practice Address - Country:US
Practice Address - Phone:330-666-0400
Practice Address - Fax:330-666-0130
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0253781223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30.025378OtherOHIO STATE DENTAL LICENSE
OH0286281Medicaid