Individual
MARIO FRAGOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1100 F AVE, DOUGLAS, AZ 85607-1919
(520) 364-1429
(520) 364-4261
Mailing address
1205 F AVENUE, DOUGLAS, AZ 85607
(520) 364-1429
(520) 364-4261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4412
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156069
—
AZ
Enumeration date
08/03/2005
Last updated
06/12/2013
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