Provider Demographics
NPI:1053818153
Name:WILLIAM JAMES FRIEDEL DDS P.C.
Entity Type:Organization
Organization Name:WILLIAM JAMES FRIEDEL DDS P.C.
Other - Org Name:WILLIAM FRIEDEL DDS P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-475-2224
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BUILDING 2 SUITE A
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-475-2224
Mailing Address - Fax:631-654-3997
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING 2 SUITE A
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-475-2224
Practice Address - Fax:631-654-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038555-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty