MEDICARE: MRS. CASEY RENE FRAZIER 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	1223P0221X	Pediatric Dentistry	17846	TX

General Provider Information

NPI Number	:	1578561924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASEY RENE FRAZIER DDS

Provider Business Mailing Address
First Line	:	100 MEDICAL CENTER PKWY, SUITE #700
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340
Country	:	US
Telephone Number	:	936-291-0804
Fax Number	:	936-291-0808

Provider Business Practice Location Address
First Line	:	100 MEDICAL CENTER PKWY, SUITE #700
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340
Country	:	US
Telephone Number	:	936-291-0804
Fax Number	:	936-291-0808

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

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

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