Provider Demographics
NPI:1952426744
Name:FRAZEE, WALTER JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JAY
Last Name:FRAZEE
Suffix:
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 1:807 WEST GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-3528
Mailing Address - Country:US
Mailing Address - Phone:501-623-1000
Mailing Address - Fax:501-623-1506
Practice Address - Street 1:807 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-3528
Practice Address - Country:US
Practice Address - Phone:501-623-1000
Practice Address - Fax:501-623-1506
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR10246768Medicaid