Provider Demographics
NPI:1295709806
Name:FRAZIER, PAUL MARK (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARK
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 CORPORATE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5416
Mailing Address - Country:US
Mailing Address - Phone:859-223-8636
Mailing Address - Fax:859-223-0448
Practice Address - Street 1:870 CORPORATE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5416
Practice Address - Country:US
Practice Address - Phone:859-223-8636
Practice Address - Fax:859-223-0448
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist