Provider Demographics
NPI:1497033872
Name:JENNIFER L.H. FRIEDMAN, DDS, PC
Entity Type:Organization
Organization Name:JENNIFER L.H. FRIEDMAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LH
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-343-0711
Mailing Address - Street 1:1600 MOUNTAIN VIEW RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4381
Mailing Address - Country:US
Mailing Address - Phone:605-343-0711
Mailing Address - Fax:605-343-1842
Practice Address - Street 1:1600 MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4381
Practice Address - Country:US
Practice Address - Phone:605-343-0711
Practice Address - Fax:605-343-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0946261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental