MEDICARE: DR. HIRAM RAYMOND FRY 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	1223P0300X	Periodontics	DS0000003614	TN

General Provider Information

NPI Number	:	1932211349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIRAM RAYMOND FRY D.D.S.

Provider Business Mailing Address
First Line	:	7960 FARINDON DR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-7114
Country	:	US
Telephone Number	:	901-755-5232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 KIRBY PKWY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-4367
Country	:	US
Telephone Number	:	901-624-7474
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/01/2026

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