Kenneth Fried, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009174 Issued in IN

Practice address

3540 E 118TH St
Chicago, IL 60617-7314

Phone

(773) 646-6262

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• United Dental Centers, LTD

  • Dentist
  • Chicago, IL
  • NPI 1275834509
  NPD (past) Authorized official
• United Dental Centers

  • Dental Clinic/Center
  • Merrillville, IN
  • NPI 1366999070
  NPD (past) Authorized official
• United Dental Centers

  • Dentist
  • Merrillville, IN
  • NPI 1477853778
  NPD (past) Authorized official

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606348800000",
    "number": "1457354441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 E 118TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606177314",
            "telephone_number": "773-646-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 E 118TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606177314",
            "telephone_number": "773-646-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIED",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2020-11-26",
        "certification_date": "2020-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019017190",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanislav Fridland
• Jennifer Friebel
• Stacy Lynn Friebus, MPT
• Alexander Mitchell Fried, DPM
• Karen Fried, PSY.D., BCBA-D
• Samantha Fried, APN
• Young Sook Fried, PHARM.D.
• Samantha Morgan Friedberg
• Friedell Clinic, S. C.
• Peter E Friedell, M. D.

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.