Provider Demographics
NPI:1932487675
Name:FRIED, JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:FRIED
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BUNN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2800
Mailing Address - Country:US
Mailing Address - Phone:609-924-1621
Mailing Address - Fax:
Practice Address - Street 1:166 BUNN DR STE 103
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2800
Practice Address - Country:US
Practice Address - Phone:609-924-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025501001223S0112X, 1223S0112X
PADS0402881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery