Healthcare Provider Details

I. General information

NPI: 1538218920
Provider Name (Legal Business Name): MICHAEL LAWRENCE FRIEDMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CHASE PKWY
WATERBURY CT
06708-3040
US

IV. Provider business mailing address

1506 PINNACLE WAY
DANBURY CT
06811-2663
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-8034
  • Fax:
Mailing address:
  • Phone: 203-798-1452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number009042
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: