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General NPI Number Information
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NPI Number | 1174640874
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Entity Type | Organization
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Legal Business Name | DR. ROBERT W. FRY, D.D.S., M.S., P.A.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 11940 QUIVIRA RD
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2222
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Country | US
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Telephone | 913-469-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 11940 QUIVIRA RD
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2222
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Country | US
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Telephone | 913-469-9191
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT W FRY
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Credential |
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Telephone | 913-469-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 5293
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License Number State | KS
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