MEDICARE: JAY R FRIEDMAN 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	33086	CA
2	1223P0700X	Prosthodontics	33086	CA

General Provider Information

NPI Number	:	1457484933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY R FRIEDMAN DDS

Provider Business Mailing Address
First Line	:	3616 ALANDER CT
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92010-5519
Country	:	US
Telephone Number	:	818-359-2076
Fax Number	:

Provider Business Practice Location Address
First Line	:	8390 LORDS PL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2926
Country	:	US
Telephone Number	:	818-359-2076
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	09/09/2020

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