Provider Demographics
NPI:1285793307
Name:FRASER, JAMES MILTON (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MILTON
Last Name:FRASER
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 1:1976 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1520
Mailing Address - Country:US
Mailing Address - Phone:810-987-7970
Mailing Address - Fax:810-987-2726
Practice Address - Street 1:1976 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1520
Practice Address - Country:US
Practice Address - Phone:810-987-7970
Practice Address - Fax:810-987-2726
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID115691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice