Healthcare Provider Details

I. General information

NPI: 1083506679
Provider Name (Legal Business Name): JULIA M FRYZEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 MEXICO RD
SAINT PETERS MO
63376-6410
US

IV. Provider business mailing address

435 BLUFF ST APT 1/2
ALTON IL
62002-6012
US

V. Phone/Fax

Practice location:
  • Phone: 636-447-4080
  • Fax:
Mailing address:
  • Phone: 708-205-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2025028486
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: