Provider Demographics
NPI:1013442078
Name:FRYML, JONATHAN ELLIOT (DMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ELLIOT
Last Name:FRYML
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1521
Mailing Address - Country:US
Mailing Address - Phone:864-416-7880
Mailing Address - Fax:864-416-7808
Practice Address - Street 1:318 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1521
Practice Address - Country:US
Practice Address - Phone:864-416-7880
Practice Address - Fax:864-416-7808
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334811223G0001X
390200000X
SC20211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program