Provider Demographics
NPI:1174744585
Name:FRYER, KENNETH DOUGLAS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DOUGLAS
Last Name:FRYER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 1250 N STE 110
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2480
Mailing Address - Country:US
Mailing Address - Phone:435-792-3033
Mailing Address - Fax:435-792-3233
Practice Address - Street 1:211 E 1250 N STE 110
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2480
Practice Address - Country:US
Practice Address - Phone:435-792-3033
Practice Address - Fax:435-792-3233
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285140-99231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry