Active NPI
Kenneth Douglas Fryer, D.D.S., M.S.
- Pediatric Dentistry
- Logan, UT
National Provider Identifier
1174744585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 285140-9923
- Practice address
- 211 E 1250 N Ste 110
Logan, UT 84341-2480 - Phone
- (435) 792-3033
- Fax
- (435) 792-3233
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 285140-9923 | UT | Primary |
Addresses
Primary practice location
211 E 1250 N Ste 110
Logan, UT 84341-2480
Mailing address
211 E 1250 N Ste 110
Logan, UT 84341-2480
Phone (435) 792-3033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 285140-9923 | UT | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523318400000",
"number": "1174744585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 E 1250 N STE 110",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412480",
"telephone_number": "435-792-3033",
"fax_number": "435-792-3233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E 1250 N STE 110",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412480",
"telephone_number": "435-792-3033",
"fax_number": "435-792-3233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRYER",
"first_name": "KENNETH",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2018-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "285140-9923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.