MEDICARE: LEE M FRIEDEL, DDS AND ELISE BOLSKI, 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	14261	FL
2	122300000X	Dentist	7855	FL

General Provider Information

NPI Number	:	1972506681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE M FRIEDEL, DDS AND ELISE BOLSKI, DDS, LLC

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

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

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. LEE M FRIEDEL
Credential	:	DDS
Telephone Number	:	954-389-0511

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/05/2007

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