MEDICARE: TW FRASER DDS CHARTERED

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	122300000X	Dentist	742	NV

General Provider Information

NPI Number	:	1518071752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TW FRASER DDS CHARTERED

Provider Business Mailing Address
First Line	:	105 MOUNT ROSE STREET
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-3419
Country	:	US
Telephone Number	:	775-323-3892
Fax Number	:	775-323-4441

Provider Business Practice Location Address
First Line	:	105 MOUNT ROSE STREET
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-3419
Country	:	US
Telephone Number	:	775-323-3892
Fax Number	:	775-323-4441

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TIMOTHY W FRASER
Credential	:	DDS
Telephone Number	:	775-323-3892

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/22/2020

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