Provider Demographics
NPI:1912997297
Name:FRIED, ALVIN DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:DONALD
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 1:4802 10TH AVE
Mailing Address - Street 2:DIVISION OF DENTISTRY/ MAIMONIDES MEDICAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2844
Mailing Address - Country:US
Mailing Address - Phone:718-283-7428
Mailing Address - Fax:718-635-7073
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:DIVISION OF DENTISTRY/ MAIMONIDES MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2844
Practice Address - Country:US
Practice Address - Phone:718-283-7428
Practice Address - Fax:718-635-7073
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01200215Medicaid
NY01200215Medicaid