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General NPI Number Information
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NPI Number | 1801080106
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Entity Type | Individual
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Provider Name | CHRISTY L FRADY D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 5810 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-1912
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Country | US
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Telephone | 414-350-0945
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Fax |
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Provider Business Mailing Address
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Address Line | 5810 S 108TH ST
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City | HALES CORNERS
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State | WI
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Zip | 53130-1912
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Country | US
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Telephone | 414-350-0945
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 6219-15
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License Number State | WI
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