MEDICARE: JEREMY FRIEDMAN DDS, LLC

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	1223G0001X	General Practice Dentistry	12010743	IN

General Provider Information

NPI Number	:	1376975615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMY FRIEDMAN DDS, LLC

Provider Business Mailing Address
First Line	:	14331 E JACKSON STREET
Second Line	:
City	:	PARKER CITY
State	:	IN
Zip	:	47368-9401
Country	:	US
Telephone Number	:	765-468-6814
Fax Number	:	765-433-2333

Provider Business Practice Location Address
First Line	:	14331 E JACKSON STREET
Second Line	:
City	:	PARKER CITY
State	:	IN
Zip	:	47368
Country	:	US
Telephone Number	:	765-468-6814
Fax Number	:	765-433-2333

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JEREMY A FRIEDMAN
Credential	:	DDS
Telephone Number	:	317-414-1616

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	03/03/2023

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