MEDICARE: LEE M. FRIEDEL D.D.S.

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	7855	FL

General Provider Information

NPI Number	:	1396888343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE M. FRIEDEL D.D.S.

Provider Business Mailing Address
First Line	:	1605 TOWN CENTER BLVD.
Second Line	:	SUITE B
City	:	WESTON
State	:	FL
Zip	:	33326
Country	:	US
Telephone Number	:	954-389-0511
Fax Number	:	954-389-5323

Provider Business Practice Location Address
First Line	:	1605 TOWN CENTER CIR
Second Line	:	SUITE B
City	:	WESTON
State	:	FL
Zip	:	33326-3637
Country	:	US
Telephone Number	:	954-389-0511
Fax Number	:	954-389-5323

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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