Provider Demographics
NPI:1811797277
Name:FRAZIER, IVEY MICHELE (DDS)
Entity type:Individual
Prefix:DR
First Name:IVEY
Middle Name:MICHELE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 AZALEA PARK DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2283
Mailing Address - Country:US
Mailing Address - Phone:615-887-9711
Mailing Address - Fax:
Practice Address - Street 1:2909 AZALEA PARK DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2283
Practice Address - Country:US
Practice Address - Phone:615-887-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
OK8075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program