MEDICARE: FRATT DENTAL CORPORATION

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

General Provider Information

NPI Number	:	1659619856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRATT DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	8611 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8611 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4001
Country	:	US
Telephone Number	:	866-898-1355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENNIS R FRATT
Credential	:	DDS
Telephone Number	:	714-428-2000

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	01/22/2013

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Directions to “FRATT DENTAL CORPORATION ” Practice Location

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