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General NPI Number Information
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NPI Number | 1104597806
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Entity Type | Organization
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Legal Business Name | FRYE DENTAL, INC.
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 814-777-7861
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 819
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City | FALL RIVER MILLS
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State | CA
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Zip | 96028-0819
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Country | US
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Telephone | 814-777-7861
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JOSHUA RYAN FRYE
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Credential | DMD
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Telephone | 814-777-7861
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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 |
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License Number State |
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