Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D8841 | OR |
NPI | 1043360167 |
---|---|
Provider Name | Dr. John Charles Frachella |
First Address | Mitchell, OR 97750-0254 |
Second Address | Redmond, OR 47756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |