MEDICARE: TEGRAN OSAFU FRAITES D.D.S

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	7277	NC

General Provider Information

NPI Number	:	1588659601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEGRAN OSAFU FRAITES D.D.S

Provider Business Mailing Address
First Line	:	101 OAK FERN LN
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-6002
Country	:	US
Telephone Number	:	910-978-8812
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 OAK FERN LN
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-6002
Country	:	US
Telephone Number	:	910-978-8812
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	06/05/2013

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