Provider Demographics
NPI:1588337216
Name:FRAZIER, EVAN (DMD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 STONEWALL HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1735
Mailing Address - Country:US
Mailing Address - Phone:901-871-6159
Mailing Address - Fax:
Practice Address - Street 1:4451 VENETUCCI BLVD UNIT 160
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4056
Practice Address - Country:US
Practice Address - Phone:719-392-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist