Individual
DR. MARC D FRIDUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4547 SAINT STEPHENS RD, EIGHT MILE, AL 36613-3563
(251) 456-1399
(251) 456-0079
Mailing address
1725 E SHERMAN BLVD, MUSKEGON, MI 49444-1862
(231) 737-0037
(231) 760-5497
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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