MEDICARE: DR. THOMAS FRIETCH 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	30.017601	OH

General Provider Information

NPI Number	:	1881012458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS FRIETCH D.D.S.

Provider Business Mailing Address
First Line	:	9017 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2401
Country	:	US
Telephone Number	:	513-385-7771
Fax Number	:	513-385-7782

Provider Business Practice Location Address
First Line	:	9017 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-2401
Country	:	US
Telephone Number	:	513-385-7771
Fax Number	:	513-385-7782

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

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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