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Individual
DR. MARC D FRIDUSS
Active
Individual
DR. MARC D FRIDUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019018828
IL
122300000X
Dentist
Primary
LNO 5731
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MEDICARE GROUP NUMBER
AL
01
—
1063439065
NPI GROUP PAYEE NUMBER
AL
05
—
630000013
—
AL
Enumeration date
06/28/2006
Last updated
05/15/2013
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