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NPI Code Detail

MEDICARE: DR. MIKAELA FRAZIER DMD

MEDICARE: DR. MIKAELA FRAZIER DMD
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
11223G0001XGeneral Practice DentistryDS041287PA
2122300000XDentist16772MD

General Provider Information

NPI Number : 1235667528
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIKAELA FRAZIER DMD
Provider Business Mailing Address
First Line : 5126 DORSEY HALL DR
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-7887
Country : US
Telephone Number : 410-740-9400
Fax Number :
Provider Business Practice Location Address
First Line : 5126 DORSEY HALL DR
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-7887
Country : US
Telephone Number : 410-740-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2017
Last Update Date : 12/02/2022

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