Provider Demographics
NPI:1184770489
Name:FRAZEE, J. THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:J. THOMAS
Middle Name:
Last Name:FRAZEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:THOMAS
Other - Last Name:FRAZEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:175 MARYS POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-4018
Mailing Address - Country:US
Mailing Address - Phone:508-763-4621
Mailing Address - Fax:
Practice Address - Street 1:61 COUNTY RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1652
Practice Address - Country:US
Practice Address - Phone:508-758-6913
Practice Address - Fax:508-758-6914
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice