Provider Demographics
NPI:1568742815
Name:FRIEDMAN, EZRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EZRA
Middle Name:
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 1:464 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2626
Mailing Address - Country:US
Mailing Address - Phone:203-879-4649
Mailing Address - Fax:203-879-5560
Practice Address - Street 1:464 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2626
Practice Address - Country:US
Practice Address - Phone:203-879-4649
Practice Address - Fax:203-879-5560
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055695122300000X
CT0112881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist