MEDICARE: DR. BRUCE A FRASZ DDS

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	14075	OH

General Provider Information

NPI Number	:	1275662900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE A FRASZ DDS

Provider Business Mailing Address
First Line	:	273 CLINE AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1019
Country	:	US
Telephone Number	:	419-756-3918
Fax Number	:	419-756-5066

Provider Business Practice Location Address
First Line	:	273 CLINE AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1019
Country	:	US
Telephone Number	:	419-756-3918
Fax Number	:	419-756-5066

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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