Provider Demographics
NPI:1487801601
Name:FRYE, RICHARD DOLAN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DOLAN
Last Name:FRYE
Suffix:JR
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 1:1323 AULT VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2514
Mailing Address - Country:US
Mailing Address - Phone:575-770-5812
Mailing Address - Fax:
Practice Address - Street 1:121 W WOODCROFT PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9471
Practice Address - Country:US
Practice Address - Phone:919-489-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44361223G0001X
NC95721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4436Medicaid