Provider Demographics
NPI:1861928533
Name:FRIED, HENRY (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:FRIED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2015 S TUTTLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4151
Mailing Address - Country:US
Mailing Address - Phone:941-221-9527
Mailing Address - Fax:
Practice Address - Street 1:2015 S TUTTLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4151
Practice Address - Country:US
Practice Address - Phone:941-221-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist