Provider Demographics
NPI:1376918474
Name:FRIBERG, BENJAMIN ISAIAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ISAIAH
Last Name:FRIBERG
Suffix:
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:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:910-371-9490
Mailing Address - Fax:
Practice Address - Street 1:2029 OLDE REGENT WAY
Practice Address - Street 2:#150
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4195
Practice Address - Country:US
Practice Address - Phone:910-371-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10359122300000X
NC10315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist