Provider Demographics
NPI:1871662486
Name:FRAZIER & KOPP DDS PC
Entity Type:Organization
Organization Name:FRAZIER & KOPP DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:I
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-477-4055
Mailing Address - Street 1:690 N IL ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3790
Mailing Address - Country:US
Mailing Address - Phone:815-477-4055
Mailing Address - Fax:815-477-4057
Practice Address - Street 1:690 N IL ROUTE 31
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3790
Practice Address - Country:US
Practice Address - Phone:815-477-4055
Practice Address - Fax:815-477-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty