Provider Demographics
NPI:1467611160
Name:FRIEDMAN, LAWRENCE JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAY
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 1:1150 PORTION RD
Mailing Address - Street 2:#13
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1074
Mailing Address - Country:US
Mailing Address - Phone:631-698-2424
Mailing Address - Fax:
Practice Address - Street 1:1150 PORTION RD
Practice Address - Street 2:#13
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1074
Practice Address - Country:US
Practice Address - Phone:631-698-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036439-011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics