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General NPI Number Information
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NPI Number | 1457834327
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Entity Type | Organization
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Legal Business Name | FRIEDMAN ORTHODONTICS
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 101 PROSPECT ST STE 200
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5003
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Country | US
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Telephone | 610-667-1984
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Fax | 610-667-2438
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Provider Business Mailing Address
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Address Line | 201 MEETING HOUSE LN
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City | MERION STATION
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State | PA
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Zip | 19066-1211
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Country | US
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Telephone | 610-617-9529
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Fax | 610-667-2438
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. SHOLOM DOVID FRIEDMAN
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Credential | DMD
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Telephone | 610-667-1984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02186300
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License Number State | NJ
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