Provider Demographics
NPI:1639275738
Name:FRIEDER, ADAM JACOB (DENTIST)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JACOB
Last Name:FRIEDER
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4505
Mailing Address - Country:US
Mailing Address - Phone:301-662-7766
Mailing Address - Fax:
Practice Address - Street 1:401 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4505
Practice Address - Country:US
Practice Address - Phone:301-662-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD92831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9283OtherLICENSE