Provider Demographics
NPI:1558458232
Name:MATHEW C. FRIEDEMANN DDS PC
Entity Type:Organization
Organization Name:MATHEW C. FRIEDEMANN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:FRIEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-362-3408
Mailing Address - Street 1:114 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-1259
Mailing Address - Country:US
Mailing Address - Phone:989-362-3408
Mailing Address - Fax:989-362-8372
Practice Address - Street 1:114 W STATE ST
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-1259
Practice Address - Country:US
Practice Address - Phone:989-362-3408
Practice Address - Fax:989-362-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty