Provider Demographics
NPI:1548289572
Name:FRY, STANLEY ALAN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ALAN
Last Name:FRY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-3821
Mailing Address - Country:US
Mailing Address - Phone:806-364-1340
Mailing Address - Fax:806-364-2216
Practice Address - Street 1:1300 W PARK AVE
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-3821
Practice Address - Country:US
Practice Address - Phone:806-364-1340
Practice Address - Fax:806-364-2216
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice