Individual
JACOB ELDON FRAZIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
110 WAKANDA DR, LEBANON, IL 62254-1393
(618) 808-0511
(618) 808-0533
Mailing address
110 WAKANDA DR, LEBANON, IL 62254-1393
(618) 808-0511
(618) 808-0533
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
021.002661
IL
1223G0001X
General Practice Dentistry
019028757
IL
Other
Enumeration date
07/15/2011
Last updated
07/19/2023
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