Provider Demographics
NPI:1124285416
Name:FRAZIER, ADA LAVONNA (DO)
Entity type:Individual
Prefix:DR
First Name:ADA
Middle Name:LAVONNA
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:11808 HWY 231/431 N
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-2126
Mailing Address - Country:US
Mailing Address - Phone:256-828-1500
Mailing Address - Fax:256-828-1515
Practice Address - Street 1:11808 HWY 231 431 N
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-2126
Practice Address - Country:US
Practice Address - Phone:256-828-1500
Practice Address - Fax:256-828-1515
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDS43101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice