Provider Demographics
NPI:1003028200
Name:FRIED, JUSTIN JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAY
Last Name:FRIED
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 1:2168 MILLBURN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2640
Mailing Address - Country:US
Mailing Address - Phone:973-763-0808
Mailing Address - Fax:973-763-0270
Practice Address - Street 1:2168 MILLBURN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2640
Practice Address - Country:US
Practice Address - Phone:973-763-0808
Practice Address - Fax:973-763-0270
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 20875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist