Provider Demographics
NPI:1801549654
Name:FRIDMAN, NARDYS (DDS)
Entity type:Individual
Prefix:DR
First Name:NARDYS
Middle Name:
Last Name:FRIDMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NARDYS
Other - Middle Name:BETANIA
Other - Last Name:ROMERO REAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27450 TOURNEY RD STE 270
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5625
Mailing Address - Country:US
Mailing Address - Phone:661-254-3700
Mailing Address - Fax:
Practice Address - Street 1:27450 TOURNEY RD STE 270
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-5625
Practice Address - Country:US
Practice Address - Phone:661-254-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1076391223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE