Provider Demographics
NPI:1366615932
Name:FRASER, ERIC D (DDS MS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:FRASER
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:140 STONY POINT RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4140
Mailing Address - Country:US
Mailing Address - Phone:707-545-8474
Mailing Address - Fax:707-578-5586
Practice Address - Street 1:140 STONY POINT RD
Practice Address - Street 2:SUITE K
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4140
Practice Address - Country:US
Practice Address - Phone:707-545-8474
Practice Address - Fax:707-578-5586
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA372201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics