Provider Demographics
NPI:1760170674
Name:KELLY M FRANDSEN DDS & ASSOCIATES
Entity Type:Organization
Organization Name:KELLY M FRANDSEN DDS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-528-7316
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0386
Mailing Address - Country:US
Mailing Address - Phone:435-528-7316
Mailing Address - Fax:435-528-7350
Practice Address - Street 1:75 N 100 E
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634
Practice Address - Country:US
Practice Address - Phone:435-528-7316
Practice Address - Fax:435-528-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental