Provider Demographics
NPI:1497850572
Name:FRYDENLUND, SAMUEL JON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JON
Last Name:FRYDENLUND
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 1:4007 WEST COURT ST
Mailing Address - Street 2:STE H
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3560
Mailing Address - Country:US
Mailing Address - Phone:810-732-3910
Mailing Address - Fax:810-732-6836
Practice Address - Street 1:2325 SHIAWASSEE
Practice Address - Street 2:SUITE 101
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1792
Practice Address - Country:US
Practice Address - Phone:810-732-3910
Practice Address - Fax:810-732-6836
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010148641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics