MEDICARE: DR. MARTIN J FRASCHETTI D.D.S.,F.I.C.C.M.O.

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	013741	MI

General Provider Information

NPI Number	:	1558482430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN J FRASCHETTI D.D.S.,F.I.C.C.M.O.

Provider Business Mailing Address
First Line	:	27731 JEFFERSON AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1309
Country	:	US
Telephone Number	:	586-773-1212
Fax Number	:	586-778-5756

Provider Business Practice Location Address
First Line	:	27731 JEFFERSON AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1309
Country	:	US
Telephone Number	:	586-773-1212
Fax Number	:	586-778-5756

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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Practice Location Address:

27731 JEFFERSON AVE
SAINT CLAIR SHORES, MI
48081-1309

Practice Phone: 586-773-1212
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Practice Location Address:

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48081-1309

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Practice Location Address:

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Practice Location Address:

27735 JEFFERSON AVE
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Practice Fax:

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Practice Location Address:

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