Jake Fried, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

057555 Issued in NY

Practice address

92 Sweet Rd
Ballston Lake, NY 12019-1804

Phone

(914) 419-4100

NPI assigned

Jan 7, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Primary Teeth Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Gloversville, NY
  • NPI 1114548617
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1063834299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 SWEET RD",
            "city": "BALLSTON LAKE",
            "state": "NY",
            "postal_code": "120191804",
            "telephone_number": "914-419-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 SWEET RD",
            "city": "BALLSTON LAKE",
            "state": "NY",
            "postal_code": "120191804",
            "telephone_number": "914-419-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIED",
        "first_name": "JAKE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-07",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "057555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irwin Bruce Finch, DDS PC
• Yolanda Fleurantin, NP
• Linda Carolyn Fragale
• Jill Frament, PHARMD
• Wilma Frederick, LMHC
• James Gaylord
• Tracey C Glogowski, M.S. ED.
• Katrina Assunta Rochon Gomez, CLC
• Holly Morgan Goodemote, PHARMD
• Christine Gravelle

• Pediatric Dentistry in Ballston Lake, NY
• Providers in Ballston Lake, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.