Provider Demographics
NPI:1043655038
Name:FRAZER, TRUDY-ANN NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:TRUDY-ANN
Middle Name:NICOLE
Last Name:FRAZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2829
Mailing Address - Country:US
Mailing Address - Phone:770-949-2400
Mailing Address - Fax:
Practice Address - Street 1:4020 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2829
Practice Address - Country:US
Practice Address - Phone:770-949-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0149711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry