Provider Demographics
NPI:1700814498
Name:FRAZIER, RODERICK L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:L
Last Name:FRAZIER
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 1:100 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2421
Mailing Address - Country:US
Mailing Address - Phone:717-218-6670
Mailing Address - Fax:717-218-6671
Practice Address - Street 1:100 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2421
Practice Address - Country:US
Practice Address - Phone:717-241-6673
Practice Address - Fax:717-218-6671
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030871R122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018203700003Medicaid