Healthcare Provider Details

I. General information

NPI: 1902839996
Provider Name (Legal Business Name): FRYE DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 GREENE ST
MARIETTA OH
45750-9172
US

IV. Provider business mailing address

1309 GREENE ST
MARIETTA OH
45750-9172
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-0123
  • Fax: 740-376-9985
Mailing address:
  • Phone: 740-374-0123
  • Fax: 740-376-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19744
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. BRET R FRYE
Title or Position: OWNER
Credential: D.D.S.
Phone: 740-374-0123