Provider Demographics
NPI:1801390992
Name:FRAIZ DENTAL GROUP P.C.
Entity Type:Organization
Organization Name:FRAIZ DENTAL GROUP P.C.
Other - Org Name:FRAIZ AND CHRISTINE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FRAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-213-3604
Mailing Address - Street 1:604 E BOULEVARD STE A
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2286
Mailing Address - Country:US
Mailing Address - Phone:765-864-2325
Mailing Address - Fax:765-453-6920
Practice Address - Street 1:604 E BOULEVARD STE A
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2286
Practice Address - Country:US
Practice Address - Phone:765-864-2325
Practice Address - Fax:765-453-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty