Provider Demographics
NPI:1932188331
Name:DAWES FRETZIN DERMATOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:DAWES FRETZIN DERMATOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:FRETZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-516-5000
Mailing Address - Street 1:7910 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2041
Mailing Address - Country:US
Mailing Address - Phone:317-516-5000
Mailing Address - Fax:317-516-5146
Practice Address - Street 1:7910 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2041
Practice Address - Country:US
Practice Address - Phone:317-516-5000
Practice Address - Fax:317-516-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty