MEDICARE: DR. CAROL A FRIEDEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5063	WA

General Provider Information

NPI Number	:	1306842703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL A FRIEDEL DDS

Provider Business Mailing Address
First Line	:	6319 24TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-2423
Country	:	US
Telephone Number	:	206-784-7171
Fax Number	:	206-781-5079

Provider Business Practice Location Address
First Line	:	6319 24TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-2423
Country	:	US
Telephone Number	:	206-784-7171
Fax Number	:	206-781-5079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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