Provider Demographics
NPI:1104881861
Name:FRYER, ROBERT M (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:FRYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE G56
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1703
Mailing Address - Country:US
Mailing Address - Phone:404-252-5626
Mailing Address - Fax:404-252-9651
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE G56
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1703
Practice Address - Country:US
Practice Address - Phone:404-252-5626
Practice Address - Fax:404-252-9651
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA81811223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300022842AMedicaid
GA850000011OtherMEDICARE RAILROAD
GA300022842AMedicaid
GA850000011OtherMEDICARE RAILROAD