Healthcare Provider Details

I. General information

NPI: 1629078738
Provider Name (Legal Business Name): TERRY C FROST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W PLANE ST
BETHEL OH
45106-1310
US

IV. Provider business mailing address

PO BOX 239
BETHEL OH
45106-0239
US

V. Phone/Fax

Practice location:
  • Phone: 513-734-7107
  • Fax: 513-734-3262
Mailing address:
  • Phone: 513-734-7107
  • Fax: 513-734-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberO17978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: