Healthcare Provider Details

I. General information

NPI: 1508386475
Provider Name (Legal Business Name): KENDALL FRAZIER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 STATE ROAD 13 STE 22
FRUIT COVE FL
32259-2821
US

IV. Provider business mailing address

3964 JEBB ISLAND CIR E
JACKSONVILLE FL
32224-7900
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-6590
  • Fax:
Mailing address:
  • Phone: 317-408-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: