Provider Demographics
NPI:1790982486
Name:ROSS A. FRASER, DDS PC
Entity Type:Organization
Organization Name:ROSS A. FRASER, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-366-6001
Mailing Address - Street 1:7627 LAKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1878
Mailing Address - Country:US
Mailing Address - Phone:708-366-6001
Mailing Address - Fax:708-366-6076
Practice Address - Street 1:7627 LAKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1878
Practice Address - Country:US
Practice Address - Phone:708-366-6001
Practice Address - Fax:708-366-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty