Provider Demographics
NPI:1801966882
Name:FRAZIER, JAMES G (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LATHROP AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1871
Mailing Address - Country:US
Mailing Address - Phone:708-366-6595
Mailing Address - Fax:708-366-6607
Practice Address - Street 1:400 LATHROP AVE STE 203
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1871
Practice Address - Country:US
Practice Address - Phone:708-366-6595
Practice Address - Fax:708-366-6607
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics