Marc D Friduss, D.D.S.
Individual provider Active NPI Dentist · Eight Mile, AL
NPI 1699702159 · NPPES record last updated May 15, 2013
Key facts
- NPI
- 1699702159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- LNO 5731 (AL)
- Practice address
- 4547 Saint Stephens Rd
Eight Mile, AL 36613-3563 - Phone
- (251) 456-1399
- Fax
- (251) 456-0079
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210114000382 | AL | Practitioner - Dentist | 7315350287 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LNO 5731 | AL | MD | Dentist |
| 019018828 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Services Inc | Current | Accepting new patients | |
| Health Services, Inc. | Current |
Accepting new patients | |
| Health Services, Inc | Current |
Accepting new patients | |
| Mobile County Board of Health | Past | Accepting new patients |
Locations
511 E Tuskeena St
Hayneville, AL 36040
Phone (334) 548-2516
2611 Woodley Park Dr
Montgomery, AL 36116
Phone (334) 288-0009
3058 Mobile Hwy
Montgomery, AL 36108
Phone (334) 293-6670
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019018828 | IL | |
| Dentist | 122300000X | LNO 5731 | AL | Yes |
Addresses
Primary practice location
4547 Saint Stephens Rd
Eight Mile, AL 36613-3563
Mailing address
1725 E Sherman Blvd
Muskegon, MI 49444-1862
Phone (231) 737-0037
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 011846 | Other | AL | MEDICARE GROUP NUMBER |
| 1063439065 | Other | AL | NPI GROUP PAYEE NUMBER |
| 630000013 | Medicaid | AL |
Other providers in Eight Mile, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.