Provider Demographics
NPI:1528540218
Name:JFRIEDMAN - ALEXANDRIA LLC
Entity Type:Organization
Organization Name:JFRIEDMAN - ALEXANDRIA LLC
Other - Org Name:ALEXANDRIA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-414-1616
Mailing Address - Street 1:14331 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PARKER CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47368-9401
Mailing Address - Country:US
Mailing Address - Phone:765-468-6814
Mailing Address - Fax:765-433-2333
Practice Address - Street 1:113 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-2021
Practice Address - Country:US
Practice Address - Phone:765-724-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120107431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty