MEDICARE: DR. DENNIS STEPHEN FRAZEE 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	1223G0001X	General Practice Dentistry	12011820A	IN

General Provider Information

NPI Number	:	1679834782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS STEPHEN FRAZEE DDS

Provider Business Mailing Address
First Line	:	100 TOWN CENTER RD S
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2321
Country	:	US
Telephone Number	:	317-584-3540
Fax Number	:	317-584-3527

Provider Business Practice Location Address
First Line	:	100 TOWN CENTER RD S
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2321
Country	:	US
Telephone Number	:	317-584-3540
Fax Number	:	317-584-3527

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	04/15/2014

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