Provider Demographics
NPI:1457413734
Name:FRIED, ANDREW THEEMAN (DMD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:THEEMAN
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 1:11410 MARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2342
Mailing Address - Country:US
Mailing Address - Phone:410-581-5334
Mailing Address - Fax:
Practice Address - Street 1:9712 BELAIR RD STE 304
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1113
Practice Address - Country:US
Practice Address - Phone:410-256-6760
Practice Address - Fax:410-256-4484
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics