Provider Demographics
NPI:1740299841
Name:FRYE, ELOISE B (RDH)
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:B
Last Name:FRYE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 LANKFORD TRL
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-9571
Mailing Address - Country:US
Mailing Address - Phone:817-741-2897
Mailing Address - Fax:309-213-1411
Practice Address - Street 1:5129 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4217
Practice Address - Country:US
Practice Address - Phone:773-631-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist