Provider Demographics
NPI:1811992027
Name:FRY, DOUGLAS STERLING SR (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STERLING
Last Name:FRY
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 S 17TH ST
Mailing Address - Street 2:STE 140
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6662
Mailing Address - Country:US
Mailing Address - Phone:910-762-7736
Mailing Address - Fax:910-251-8845
Practice Address - Street 1:1911 S 17TH ST
Practice Address - Street 2:STE 140
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6662
Practice Address - Country:US
Practice Address - Phone:910-762-7736
Practice Address - Fax:910-251-8845
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36741223P0221X
TN22671223P0221X
NE53841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992924Medicaid
NC92924OtherBCBS