=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891902854
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON JOSIANNE FRIEND DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 03/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1520 N. EL CAMINO REAL SUITE #5
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-366-1111
-----------------------------------------------------
Fax | 860-536-7403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 CANTILENA
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-961-2948
-----------------------------------------------------
Fax | 860-536-7403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 41298
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------