MEDICARE: JAMES R FRICTON 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	122300000X	Dentist	D9054	MN
2	1223X2210X	Orofacial Pain Dentistry	D9054	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	434102	OTHER	MN	MEDICA
2	3D757FR	OTHER	MN	BLUE CROSS

General Provider Information

NPI Number	:	1639103682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R FRICTON DDS

Provider Business Mailing Address
First Line	:	3475 PLYMOUTH BLVD STE 200
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1539
Country	:	US
Telephone Number	:	763-577-2484
Fax Number	:	763-577-1375

Provider Business Practice Location Address
First Line	:	3475 PLYMOUTH BLVD STE 200
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-1539
Country	:	US
Telephone Number	:	763-577-2484
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/17/2024

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