Individual
DR. KENNETH FRIED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3540 E 118TH ST, CHICAGO, IL 60617-7314
(773) 646-6262
Mailing address
3540 E 118TH ST, CHICAGO, IL 60617-7314
(773) 646-6262
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019017190
IL
1223G0001X
General Practice Dentistry
Primary
12009174
IN
Other
Enumeration date
05/24/2005
Last updated
11/26/2020
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