Provider Demographics
NPI:1215952353
Name:FRIED, MARK (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
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 1:61 EDGELL RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4834
Mailing Address - Country:US
Mailing Address - Phone:508-872-9339
Mailing Address - Fax:508-872-6246
Practice Address - Street 1:61 EDGELL RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4834
Practice Address - Country:US
Practice Address - Phone:508-872-9339
Practice Address - Fax:508-872-6246
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist