Provider Demographics
NPI:1316154081
Name:FRAZIER, MARIAH LEANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:LEANNE
Last Name:FRAZIER
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 1:6943 W 37TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9302
Mailing Address - Country:US
Mailing Address - Phone:316-613-2077
Mailing Address - Fax:316-613-2969
Practice Address - Street 1:6943 W 37TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9302
Practice Address - Country:US
Practice Address - Phone:316-613-2077
Practice Address - Fax:316-613-2969
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS605181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program