Provider Demographics
NPI:1992180012
Name:ANDREW FRIED, DMD LLC
Entity Type:Organization
Organization Name:ANDREW FRIED, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-256-6760
Mailing Address - Street 1:9712 BELAIR ROAD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-256-6760
Mailing Address - Fax:410-256-4484
Practice Address - Street 1:9712 BELAIR ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-256-6760
Practice Address - Fax:410-256-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13443261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental