Provider Demographics
NPI:1710419353
Name:FRYBERG, HARRISON DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:DANIEL
Last Name:FRYBERG
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 1:7160 E KIERLAND BLVD APT 811
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2995
Mailing Address - Country:US
Mailing Address - Phone:310-595-4903
Mailing Address - Fax:
Practice Address - Street 1:7160 E KIERLAND BLVD APT 811
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2995
Practice Address - Country:US
Practice Address - Phone:310-595-4903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0110351223S0112X, 204E00000X
CA1021281223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery