Healthcare Provider Details

I. General information

NPI: 1013753672
Provider Name (Legal Business Name): REID ALEXANDER FRYE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 FOOTHILL BLVD
SALT LAKE CITY UT
84113-1106
US

IV. Provider business mailing address

2191 S MCCLELLAND ST APT 641
SALT LAKE CITY UT
84106-4562
US

V. Phone/Fax

Practice location:
  • Phone: 801-584-1206
  • Fax:
Mailing address:
  • Phone: 724-366-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14261139
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: