Provider Demographics
NPI:1902839996
Name:FRYE DENTAL GROUP LLC
Entity Type:Organization
Organization Name:FRYE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-374-0123
Mailing Address - Street 1:1309 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9172
Mailing Address - Country:US
Mailing Address - Phone:740-374-0123
Mailing Address - Fax:740-376-9985
Practice Address - Street 1:1309 GREENE ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-9172
Practice Address - Country:US
Practice Address - Phone:740-374-0123
Practice Address - Fax:740-376-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19744122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty