MEDICARE: DR. BRUCE DAVID 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	1223P0221X	Pediatric Dentistry	11417	TX

General Provider Information

NPI Number	:	1467448209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE DAVID FRIEDMAN DDS

Provider Business Mailing Address
First Line	:	2201 W HOLCOMBE BLVD
Second Line	:	SUITE 205
City	:	HOUSTON
State	:	TX
Zip	:	77030-2096
Country	:	US
Telephone Number	:	713-665-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 W HOLCOMBE BLVD
Second Line	:	SUITE 205
City	:	HOUSTON
State	:	TX
Zip	:	77030-2096
Country	:	US
Telephone Number	:	713-665-1818
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/08/2007

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