Healthcare Provider Details

I. General information

NPI: 1306842703
Provider Name (Legal Business Name): CAROL A FRIEDEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6319 24TH AVE NW
SEATTLE WA
98107-2423
US

IV. Provider business mailing address

6319 24TH AVE NW
SEATTLE WA
98107-2423
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-7171
  • Fax: 206-781-5079
Mailing address:
  • Phone: 206-784-7171
  • Fax: 206-781-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: