Provider Demographics
NPI:1790828390
Name:FRALICK JR., LEONARD G (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:G
Last Name:FRALICK JR.
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-0579
Mailing Address - Country:US
Mailing Address - Phone:715-365-1800
Mailing Address - Fax:715-365-1806
Practice Address - Street 1:521 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2855
Practice Address - Country:US
Practice Address - Phone:715-365-1800
Practice Address - Fax:715-365-1806
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist