MEDICARE: FRATT DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1073720892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRATT DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	11001 BEACH BLVD
Second Line	:
City	:	STANTON
State	:	CA
Zip	:	90680-3216
Country	:	US
Telephone Number	:	714-891-6623
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 BEACH BLVD
Second Line	:
City	:	STANTON
State	:	CA
Zip	:	90680-3216
Country	:	US
Telephone Number	:	714-891-6623
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DENNIS R FRATT
Credential	:	DDS
Telephone Number	:	714-428-1200

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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