Provider Demographics
NPI:1376987388
Name:UNIVERSITY DENTAL ASSOCIATES, L.L.P.
Entity Type:Organization
Organization Name:UNIVERSITY DENTAL ASSOCIATES, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-283-7428
Mailing Address - Street 1:427 RIDGEWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4205
Mailing Address - Country:US
Mailing Address - Phone:718-283-7428
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:DIVISION OF DENTISTRY/MAIMONIDES MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-21
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355091223G0001X
NY0248251223G0001X
NY0378371223P0221X
NY0490901223P0221X
NY0440161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty