Provider Demographics
NPI:1083506679
Name:FRYZEL, JULIA M (DMD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:FRYZEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 BLUFF ST APT 1/2
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6012
Mailing Address - Country:US
Mailing Address - Phone:708-205-5133
Mailing Address - Fax:
Practice Address - Street 1:4125 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6410
Practice Address - Country:US
Practice Address - Phone:636-447-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250284861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice