Provider Demographics
NPI:1588659601
Name:FRAITES, TEGRAN OSAFU (DDS)
Entity type:Individual
Prefix:
First Name:TEGRAN
Middle Name:OSAFU
Last Name:FRAITES
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 1:101 OAK FERN LN
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-6002
Mailing Address - Country:US
Mailing Address - Phone:910-978-8812
Mailing Address - Fax:
Practice Address - Street 1:101 OAK FERN LN
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-6002
Practice Address - Country:US
Practice Address - Phone:910-978-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice