Provider Demographics
NPI:1932211349
Name:FRY, HIRAM RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:RAYMOND
Last Name:FRY
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 1:7960 FARINDON DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7114
Mailing Address - Country:US
Mailing Address - Phone:901-755-5232
Mailing Address - Fax:
Practice Address - Street 1:1721 KIRBY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4367
Practice Address - Country:US
Practice Address - Phone:901-624-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000036141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics