Provider Demographics
NPI:1518857911
Name:EVAN J FRY, DMD PLLC
Entity type:Organization
Organization Name:EVAN J FRY, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-352-7358
Mailing Address - Street 1:4727 WILLOW SPRINGS RD STE 1N
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6153
Mailing Address - Country:US
Mailing Address - Phone:708-352-7358
Mailing Address - Fax:
Practice Address - Street 1:4727 WILLOW SPRINGS RD STE 1N
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6153
Practice Address - Country:US
Practice Address - Phone:708-352-7358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental