Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 27097 | TX |
N | 1223P0106X | Oral and Maxillofacial Pathology | 27097 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 27097 | TX |
NPI | 1003102435 |
---|---|
Provider Name | Dr. Kyle Bryan Frazier |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 30/03/2015 |