Provider Demographics
NPI:1003819657
Name:FRIEDMAN, ROBERT HARRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HARRIS
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86175 MEADOWFIELD BLUFFS RD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-8412
Mailing Address - Country:US
Mailing Address - Phone:904-556-4692
Mailing Address - Fax:904-261-8181
Practice Address - Street 1:450031 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-3847
Practice Address - Country:US
Practice Address - Phone:904-879-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL107491223G0001X
FLDN10749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice