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General NPI Number Information
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NPI Number | 1245609049
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Entity Type | Organization
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Legal Business Name | ROBERT L FRIESS DMD PC
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 3295 TRIANGLE DR SE STE 242
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City | SALEM
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State | OR
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Zip | 97302-4579
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Country | US
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Telephone | 503-585-0101
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Fax | 503-585-6365
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Provider Business Mailing Address
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Address Line | 3295 TRIANGLE DR SE STE 242
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City | SALEM
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State | OR
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Zip | 97302-4579
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Country | US
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Telephone | 503-585-0101
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Fax | 503-585-6365
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT FRIESS
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Credential | DMD
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Telephone | 503-585-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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