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General NPI Number Information
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NPI Number | 1669109401
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Entity Type | Individual
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Provider Name | FRIDA DAVYDOV DDS
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Gender | Female
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 1990 W MAIN ST
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City | STAMFORD
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State | CT
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Zip | 06902-4563
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Country | US
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Telephone | 203-327-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 8006 209TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1009
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Country | US
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Telephone | 917-568-1011
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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 | 13532
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License Number State | CT
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