Individual
JEREMIAH J FRASIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5430 E WASHINGTON ST, INDIANAPOLIS, IN 46219-6446
(317) 322-1840
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010442A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200487570
—
IN
Enumeration date
11/10/2006
Last updated
12/28/2010
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