Provider Demographics
NPI:1679987630
Name:BRYAN FRIEDLAND DMD PC
Entity Type:Organization
Organization Name:BRYAN FRIEDLAND DMD PC
Other - Org Name:CHEMUNG DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JARROD
Authorized Official - Last Name:FRIEDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-795-5000
Mailing Address - Street 1:170 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1844
Mailing Address - Country:US
Mailing Address - Phone:607-795-5000
Mailing Address - Fax:607-739-3166
Practice Address - Street 1:170 MILLER ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1844
Practice Address - Country:US
Practice Address - Phone:607-795-5000
Practice Address - Fax:607-739-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty