Provider Demographics
NPI:1265568901
Name:SAYRE, FRED L (DMD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:L
Last Name:SAYRE
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 1:705 W SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6834
Mailing Address - Country:US
Mailing Address - Phone:406-728-4032
Mailing Address - Fax:406-728-7380
Practice Address - Street 1:705 W SUSSEX AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6834
Practice Address - Country:US
Practice Address - Phone:406-728-4032
Practice Address - Fax:406-728-7380
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics