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General NPI Number Information
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NPI Number | 1154490498
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Entity Type | Individual
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Provider Name | ROBERT ALAN FRIEDSTAT DDS
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 64 OLD ORCHARD SHOPPING CTR SUITE 535
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City | SKOKIE
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State | IL
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Zip | 60077-1425
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Country | US
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Telephone | 847-674-5556
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Fax | 847-674-8876
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Provider Business Mailing Address
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Address Line | 1022 KNOLL LN
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City | WILMETTE
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State | IL
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Zip | 60091-1448
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Country | US
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Telephone | 847-256-6184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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