Healthcare Provider Details

I. General information

NPI: 1467448209
Provider Name (Legal Business Name): BRUCE DAVID FRIEDMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: BRUCE DAVID FRIEDMAN DDS

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 W HOLCOMBE BLVD SUITE 205
HOUSTON TX
77030-2096
US

IV. Provider business mailing address

2201 W HOLCOMBE BLVD SUITE 205
HOUSTON TX
77030-2096
US

V. Phone/Fax

Practice location:
  • Phone: 713-665-1818
  • Fax:
Mailing address:
  • Phone: 713-665-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: