Healthcare Provider Details

I. General information

NPI: 1457435984
Provider Name (Legal Business Name): DAVID LEON FRIED DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAIN ST
YALESVILLE CT
06492
US

IV. Provider business mailing address

329 MAIN ST
YALESVILLE CT
06492
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-7118
  • Fax: 203-294-0620
Mailing address:
  • Phone: 203-265-7118
  • Fax: 203-294-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7541
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: