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General NPI Number Information
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NPI Number | 1457413734
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Entity Type | Individual
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Provider Name | ANDREW THEEMAN FRIED DMD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 9712 BELAIR RD STE 304
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City | BALTIMORE
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State | MD
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Zip | 21236-1113
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Country | US
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Telephone | 410-256-6760
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Fax | 410-256-4484
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Provider Business Mailing Address
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Address Line | 11410 MARBROOK RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-2342
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Country | US
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Telephone | 410-581-5334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 13443
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License Number State | MD
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