MEDICARE: FRAZEE FAMILY DENTISTRY LLC

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
1	122300000X	Dentist	12011820	IN

General Provider Information

NPI Number	:	1215384193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRAZEE FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	100 TOWN CENTER RD S
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2321
Country	:	US
Telephone Number	:	317-584-3540
Fax Number	:	317-584-3527

Provider Business Practice Location Address
First Line	:	100 TOWN CENTER RD S
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2321
Country	:	US
Telephone Number	:	317-584-3540
Fax Number	:	317-584-3527

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DENNIS S FRAZEE
Credential	:	DDS
Telephone Number	:	317-584-3540

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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