Healthcare Provider Details

I. General information

NPI: 1104881861
Provider Name (Legal Business Name): ROBERT M FRYER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD NE SUITE G56
ATLANTA GA
30342-1703
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD NE SUITE G56
ATLANTA GA
30342-1703
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-5626
  • Fax: 404-252-9651
Mailing address:
  • Phone: 404-252-5626
  • Fax: 404-252-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number8181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: