Provider Demographics
NPI:1568678027
Name:FRIEDERICHS, GEORGE L (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:FRIEDERICHS
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 1:315 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-4861
Mailing Address - Country:US
Mailing Address - Phone:810-329-0924
Mailing Address - Fax:
Practice Address - Street 1:315 ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-4861
Practice Address - Country:US
Practice Address - Phone:810-329-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist