Healthcare Provider Details

I. General information

NPI: 1053818153
Provider Name (Legal Business Name): WILLIAM JAMES FRIEDEL DDS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SILLS RD BUILDING 2 SUITE A
EAST PATCHOGUE NY
11772-4869
US

IV. Provider business mailing address

285 SILLS RD BUILDING 2 SUITE A
EAST PATCHOGUE NY
11772-4869
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-2224
  • Fax: 631-654-3997
Mailing address:
  • Phone: 631-475-2224
  • Fax: 631-654-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number038555-1
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM JAMES FRIEDEL
Title or Position: OWNER
Credential: DDS
Phone: 631-475-2224