Provider Demographics
NPI:1972633899
Name:FRODEL, GREG W (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:W
Last Name:FRODEL
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 1:5204 N ROAD 68
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9275
Mailing Address - Country:US
Mailing Address - Phone:509-547-9955
Mailing Address - Fax:509-544-2827
Practice Address - Street 1:5204 N ROAD 68
Practice Address - Street 2:SUITE B
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9275
Practice Address - Country:US
Practice Address - Phone:509-547-9955
Practice Address - Fax:509-544-2827
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5567OtherSTATE LICENSE NUMBER
WA5778OtherDELTA DENTAL INSURANCE
WA5051891Medicaid