Provider Demographics
NPI:1942057583
Name:BUCKEYE DENTAL IMPLANTS & ORAL SURGERY
Entity type:Organization
Organization Name:BUCKEYE DENTAL IMPLANTS & ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-595-4903
Mailing Address - Street 1:865 S WATSON RD STE 218
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3470
Mailing Address - Country:US
Mailing Address - Phone:623-704-7701
Mailing Address - Fax:623-304-0177
Practice Address - Street 1:865 S WATSON RD STE 218
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3470
Practice Address - Country:US
Practice Address - Phone:623-304-7701
Practice Address - Fax:623-304-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty