Provider Demographics
NPI:1366584450
Name:FRIEDMAN, MITCHEL LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:LEE
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1425
Mailing Address - Country:US
Mailing Address - Phone:732-741-6444
Mailing Address - Fax:732-741-8121
Practice Address - Street 1:539 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1425
Practice Address - Country:US
Practice Address - Phone:732-741-6444
Practice Address - Fax:732-741-8121
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ147961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice