Provider Demographics
NPI:1922194570
Name:FRASER, MAUREEN O (DDS)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:O
Last Name:FRASER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3653
Mailing Address - Country:US
Mailing Address - Phone:732-826-8464
Mailing Address - Fax:732-826-4022
Practice Address - Street 1:505 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3653
Practice Address - Country:US
Practice Address - Phone:732-826-8464
Practice Address - Fax:732-826-4022
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101529300122300000X
NJ22D1021886011223S0112X
NJ22D1022036081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1835904Medicaid
NJ3300102Medicaid