Provider Demographics
NPI:1245264951
Name:FRASER, JAMES ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
Last Name:FRASER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953
Mailing Address - Country:US
Mailing Address - Phone:740-264-5363
Mailing Address - Fax:740-264-7334
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953
Practice Address - Country:US
Practice Address - Phone:740-264-5363
Practice Address - Fax:740-264-7334
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30014940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384703Medicaid