Provider Demographics
NPI:1124077557
Name:FRIE, DOUGLAS ROGER (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ROGER
Last Name:FRIE
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 1:794 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4702
Mailing Address - Country:US
Mailing Address - Phone:516-486-4440
Mailing Address - Fax:
Practice Address - Street 1:794 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4702
Practice Address - Country:US
Practice Address - Phone:516-486-4440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029493-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist