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General NPI Number Information
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NPI Number | 1013442078
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Entity Type | Individual
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Provider Name | JONATHAN ELLIOT FRYML DMD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 318 MEMORIAL DR
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City | GREER
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State | SC
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Zip | 29650-1521
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Country | US
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Telephone | 864-416-7880
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Fax | 864-416-7808
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Provider Business Mailing Address
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Address Line | 318 MEMORIAL DR
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City | GREER
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State | SC
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Zip | 29650-1521
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Country | US
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Telephone | 864-416-7880
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Fax | 864-416-7808
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33481
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2021
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License Number State | SC
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