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NPI Code Detail

MEDICARE: DR. KEVIN BRADLEY FRAZIER DMD, ED.S

MEDICARE: DR. KEVIN BRADLEY FRAZIER DMD, ED.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN9605FL
2122300000XDentistDNF000246GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134173578
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN BRADLEY FRAZIER DMD, ED.S
Provider Business Mailing Address
First Line : 1430 JOHN WESLEY GILBERT DRIVE GC-1012
Second Line :
City : AUGUSTA
State : GA
Zip : 30912-0001
Country : US
Telephone Number : 706-721-2371
Fax Number : 706-721-6778
Provider Business Practice Location Address
First Line : 1430 JOHN WESLEY GILBERT DRIVE
Second Line :
City : AUGUSTA
State : GA
Zip : 30912-1001
Country : US
Telephone Number : 706-721-2371
Fax Number : 706-721-6778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 02/19/2026

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