Provider Demographics
NPI:1275762759
Name:FRASER, ANDREA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
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 1:9900 SW WILSHIRE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5065
Mailing Address - Country:US
Mailing Address - Phone:971-271-7478
Mailing Address - Fax:
Practice Address - Street 1:9900 SW WILSHIRE ST STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5065
Practice Address - Country:US
Practice Address - Phone:971-271-7478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ORD10566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies