Provider Demographics
NPI:1568468387
Name:FRIED, DANIEL IRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:IRA
Last Name:FRIED
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 CROSSROADS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5458
Mailing Address - Country:US
Mailing Address - Phone:410-363-7780
Mailing Address - Fax:410-581-9724
Practice Address - Street 1:10 CROSSROADS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5458
Practice Address - Country:US
Practice Address - Phone:410-363-7780
Practice Address - Fax:410-581-9724
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD085311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59469Medicare UPIN