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General NPI Number Information
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NPI Number | 1225696248
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Entity Type | Individual
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Provider Name | CHRISTOPHER J FRONCZAK D.D.S
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Gender | Male
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 8080 MOORSBRIDGE RD STE 101
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City | PORTAGE
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State | MI
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Zip | 49024-4422
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Country | US
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Telephone | 269-679-6159
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Fax |
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Provider Business Mailing Address
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Address Line | 563 RIVERBANK ST
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City | LINCOLN PARK
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State | MI
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Zip | 48146-4315
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Country | US
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Telephone | 313-515-0465
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Fax |
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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 | 2901600110
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License Number State | MI
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