Provider Demographics
NPI:1700959434
Name:FRYER, KEVIN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WILLIAM
Last Name:FRYER
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 1:2860 BISHOP RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2670
Mailing Address - Country:US
Mailing Address - Phone:440-585-4200
Mailing Address - Fax:440-585-4211
Practice Address - Street 1:2860 BISHOP RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2670
Practice Address - Country:US
Practice Address - Phone:440-585-4200
Practice Address - Fax:440-585-4211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice