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General NPI Number Information
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NPI Number | 1174884753
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Entity Type | Organization
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Legal Business Name | RUSSELL N. FRYS JR,, DDS PA
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 7550 FRANCE AVE SOUTH SUITE 138
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City | EDINA
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State | MN
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Zip | 55435-4761
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Country | US
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Telephone | 952-831-1332
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Fax | 952-831-0553
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Provider Business Mailing Address
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Address Line | 7550 FRANCE AVE S SUITE 138
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City | EDINA
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State | MN
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Zip | 55435-5624
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Country | US
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Telephone | 952-831-1332
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Fax | 952-831-0553
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSSELL NICHOLAS FRYS
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Credential | DDS
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Telephone | 952-831-1332
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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 | 8040
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License Number State | MN
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