Michael Kristopher Frazier, DMD
Individual provider Active NPI Dentist · Rochelle, GA
NPI 1841452364 · NPPES record last updated Nov 26, 2013
Key facts
- NPI
- 1841452364
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN013710 (GA)
- Practice address
- 615 2ND Ave
Rochelle, GA 31079-2055 - Phone
- (229) 365-0056
- Fax
- (229) 365-7737
- NPI assigned
- Jun 26, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150410002294 | GA | Order and Referring Only - Dentist |
9537487152 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rochelle Dental | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN013710 | GA | Yes |
Addresses
Primary practice location
615 2ND Ave
Rochelle, GA 31079-2055
Mailing address
PO Box 247
Rochelle, GA 31079-0247
Phone (229) 365-0056
Other providers in Rochelle, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.