Provider Demographics
NPI:1801960133
Name:FRITTS, WAYNE KING (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:KING
Last Name:FRITTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 BRADFORD WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-9800
Mailing Address - Country:US
Mailing Address - Phone:865-376-4089
Mailing Address - Fax:865-376-6261
Practice Address - Street 1:1000 BRADFORD WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-9800
Practice Address - Country:US
Practice Address - Phone:865-376-4089
Practice Address - Fax:865-376-6261
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0021561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice