Provider Demographics
NPI:1205924735
Name:FRIED, BRUCE MARC (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARC
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 1:650 S RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3446
Mailing Address - Country:US
Mailing Address - Phone:717-846-5284
Mailing Address - Fax:717-843-3951
Practice Address - Street 1:650 S RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3446
Practice Address - Country:US
Practice Address - Phone:717-846-5284
Practice Address - Fax:717-843-3951
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025288L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS-025288LOtherDENTAL LICENSE