Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | AZ6685 | AZ |
NPI | 1134453152 |
---|---|
Provider Name | Miss Angel Marie Frye |
First Address | Surprise, AZ 85374 |
Second Address | Litchfield, AZ 85340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2009 |
Last Update Date | 23/09/2009 |