Provider Demographics
NPI:1831318906
Name:FRIEDER, DENNIS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:FRIEDER
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 1:490B W ZIA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7008
Mailing Address - Country:US
Mailing Address - Phone:505-992-1550
Mailing Address - Fax:505-992-1557
Practice Address - Street 1:490B W ZIA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7008
Practice Address - Country:US
Practice Address - Phone:505-992-1550
Practice Address - Fax:505-992-1557
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD18181223S0112X
CA198791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery