John Douglas Frazee, DDS
Individual provider Active NPI Dentist · Sparta, WI
NPI 1689714487 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689714487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5002093 (WI)
- Practice address
- 311 Jefferson Avenue
Sparta, WI 54656-2113 - Phone
- (608) 269-5008
- Fax
- (608) 269-5018
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5002093 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sparta Family Dentistry, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5002093 | WI | Yes |
Addresses
Primary practice location
311 Jefferson Avenue
Sparta, WI 54656-2113
Mailing address
8504 County Hwy BC
Sparta, WI 54656
Phone (608) 269-4290
Other providers in Sparta, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.