Provider Demographics
NPI:1780745950
Name:FRYAR AND DAVIDSON DENTISTRY PARTNERSHIP
Entity type:Organization
Organization Name:FRYAR AND DAVIDSON DENTISTRY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FRYAR
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-663-1800
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115
Mailing Address - Country:US
Mailing Address - Phone:704-663-1800
Mailing Address - Fax:704-662-9569
Practice Address - Street 1:134 N MAGNOLIA STREET
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115
Practice Address - Country:US
Practice Address - Phone:704-663-1800
Practice Address - Fax:704-662-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017N5OtherBCBS OF NC
887074OtherUNITED CONCORDIA