Provider Demographics
NPI:1740842251
Name:FRYS, TONYA MARIE (DMD)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:FRYS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 SW 24TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7872
Mailing Address - Country:US
Mailing Address - Phone:336-407-0371
Mailing Address - Fax:
Practice Address - Street 1:250 S CHESTNUT ST STE 30
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3031
Practice Address - Country:US
Practice Address - Phone:330-297-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24246122300000X
OH30.025901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist