Healthcare Provider Details

I. General information

NPI: 1558458232
Provider Name (Legal Business Name): MATHEW C. FRIEDEMANN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W STATE ST
EAST TAWAS MI
48730-1259
US

IV. Provider business mailing address

114 W STATE ST
EAST TAWAS MI
48730-1259
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-3408
  • Fax: 989-362-8372
Mailing address:
  • Phone: 989-362-3408
  • Fax: 989-362-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901010423
License Number StateMI

VIII. Authorized Official

Name: DR. MATHEW CONRAD FRIEDEMANN
Title or Position: PRESIDENT
Credential: DDS
Phone: 989-362-3408