Healthcare Provider Details

I. General information

NPI: 1558854398
Provider Name (Legal Business Name): KATHERINE L. FRY DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 AKERS MILL RD SE STE 225
ATLANTA GA
30339-3124
US

IV. Provider business mailing address

1387 PIERCE AVE SE
SMYRNA GA
30080-2148
US

V. Phone/Fax

Practice location:
  • Phone: 678-990-3363
  • Fax:
Mailing address:
  • Phone: 678-990-3363
  • Fax: 678-401-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE FRY HIDI
Title or Position: PRESIDENT
Credential: DMD
Phone: 205-901-4585