MEDICARE: DR. ROSS ANDREW FRASER D.D.S.

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		IL

General Provider Information

NPI Number	:	1215918198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS ANDREW FRASER D.D.S.

Provider Business Mailing Address
First Line	:	7627 LAKE ST
Second Line	:	SUITE 200
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1878
Country	:	US
Telephone Number	:	708-366-6001
Fax Number	:	708-366-6001

Provider Business Practice Location Address
First Line	:	7627 LAKE ST
Second Line	:	SUITE 200
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1878
Country	:	US
Telephone Number	:	708-366-6001
Fax Number	:	708-366-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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