Provider Demographics
NPI:1942237110
Name:FRYKMAN, IAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:C
Last Name:FRYKMAN
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 1:625 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-435-0321
Mailing Address - Fax:952-435-0369
Practice Address - Street 1:625 E NICOLLET BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-435-0321
Practice Address - Fax:952-435-0369
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND79601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22713FROtherBCBS
MN367013900Medicaid
851144OtherUNITED CANCORDIA