Provider Demographics
NPI:1972697639
Name:FRIAS, EMMANUEL ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ANTONIO
Last Name:FRIAS
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 1:15 FIRETHORN LN
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3710
Mailing Address - Country:US
Mailing Address - Phone:347-683-0041
Mailing Address - Fax:
Practice Address - Street 1:1044 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1507
Practice Address - Country:US
Practice Address - Phone:401-722-4086
Practice Address - Fax:401-475-1875
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049230-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02145751Medicaid
NY9176819OtherDORAL OFFICE LOCATION