Healthcare Provider Details

I. General information

NPI: 1386902245
Provider Name (Legal Business Name): ALAN P. FRIEDLER, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 WHALLEY AVE SUITE 101
NEW HAVEN CT
06511-3019
US

IV. Provider business mailing address

419 WHALLEY AVE SUITE 101
NEW HAVEN CT
06511-3019
US

V. Phone/Fax

Practice location:
  • Phone: 203-787-0520
  • Fax: 203-624-7882
Mailing address:
  • Phone: 203-787-0520
  • Fax: 203-624-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5430
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number5430
License Number StateCT

VIII. Authorized Official

Name: DR. ALAN PAUL FRIEDLER
Title or Position: OWNER
Credential: D.M.D.
Phone: 203-787-0520