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General NPI Number Information
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NPI Number | 1689231078
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Entity Type | Individual
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Provider Name | MEGAN MARIE FRIED DDS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1573 154TH AVE NW STE 105
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City | ANDOVER
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State | MN
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Zip | 55304-2696
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Country | US
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Telephone | 763-427-2740
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Fax |
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Provider Business Mailing Address
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Address Line | 402 MONROE ST
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City | ANOKA
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State | MN
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Zip | 55303-2516
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Country | US
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Telephone | 763-427-2740
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D14220
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D14220
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License Number State | MN
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