Healthcare Provider Details

I. General information

NPI: 1790761815
Provider Name (Legal Business Name): ALLEN L FRIEDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 BOSTON RD
BILLERICA MA
01821-1819
US

IV. Provider business mailing address

13 MARK VINCENT DR
WESTFORD MA
01886-4504
US

V. Phone/Fax

Practice location:
  • Phone: 978-667-8600
  • Fax: 978-663-2880
Mailing address:
  • Phone: 978-692-7197
  • Fax: 978-663-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number700690
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: