Provider Demographics
NPI:1568562692
Name:FRIED, CLIFFERD BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFERD
Middle Name:BRUCE
Last Name:FRIED
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 1:251 N PROGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1927
Mailing Address - Country:US
Mailing Address - Phone:717-657-7645
Mailing Address - Fax:717-657-5410
Practice Address - Street 1:251 N PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1927
Practice Address - Country:US
Practice Address - Phone:717-657-7645
Practice Address - Fax:717-657-5410
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0195351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice