Provider Demographics
NPI:1154405231
Name:FROKJER, GREG M (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:M
Last Name:FROKJER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165C SOUTH COLUMBIA ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4007
Mailing Address - Country:US
Mailing Address - Phone:701-772-7379
Mailing Address - Fax:701-772-9643
Practice Address - Street 1:1165C SOUTH COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4007
Practice Address - Country:US
Practice Address - Phone:701-772-7379
Practice Address - Fax:701-772-9643
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00Q48FROtherBCBS
ND17834Medicaid
T61955Medicare UPIN
ND15419Medicare ID - Type UnspecifiedND BLUE CROSS BLUE SHIELD