Provider Demographics
NPI:1528235116
Name:FRODGE, HEATHER RAE (DMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RAE
Last Name:FRODGE
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 1:804 TOWN BOULEVARD
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319
Mailing Address - Country:US
Mailing Address - Phone:404-631-6277
Mailing Address - Fax:404-631-6278
Practice Address - Street 1:804 TOWN BLVD NE
Practice Address - Street 2:SUITE 2010
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-3147
Practice Address - Country:US
Practice Address - Phone:404-631-6277
Practice Address - Fax:404-631-6278
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist