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NPI Code Detail

MEDICARE: DR. MARC D FRIDUSS D.D.S.

MEDICARE:  DR. MARC D FRIDUSS  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019018828IL
2122300000XDentistLNO 5731AL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1011846OTHERALMEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21063439065OTHERALNPI GROUP PAYEE NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699702159
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC D FRIDUSS D.D.S.
Provider Business Mailing Address
First Line : 1725 E SHERMAN BLVD
Second Line :
City : MUSKEGON
State : MI
Zip : 49444-1862
Country : US
Telephone Number : 231-737-0037
Fax Number : 231-760-5497
Provider Business Practice Location Address
First Line : 4547 SAINT STEPHENS RD
Second Line :
City : EIGHT MILE
State : AL
Zip : 36613-3563
Country : US
Telephone Number : 251-456-1399
Fax Number : 251-456-0079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 05/15/2013

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Directions to “ DR. MARC D FRIDUSS D.D.S.” Practice Location

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