Provider Information for 1407422421
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Dr. EVAN JAMES FRY DMD
Sex: Male
NPI: 1407422421
Last Updated: 2024-01-31
Certification Date: 2024-01-31
Certification Date: 2024-01-31
Details
Name | Value | ||||||||||||
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NPI | 1407422421 | ||||||||||||
Enumeration Date | 2021-06-01 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 4727 WILLOW SPRINGS RD STE 1N LA GRANGE, IL 60525-6153 United States Phone: 312-203-5930 | Fax: | ||||||||||||
Primary Practice Address | 4727 WILLOW SPRINGS RD STE 1N LA GRANGE, IL 60525-6153 United States Phone: 708-352-7358 | Fax: | ||||||||||||
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