Provider Demographics
NPI:1760672158
Name:FRIEDRICH, MICHAL ROMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:ROMAN
Last Name:FRIEDRICH
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 1:14 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2319
Mailing Address - Country:US
Mailing Address - Phone:206-284-2136
Mailing Address - Fax:206-284-3559
Practice Address - Street 1:14 BOSTON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2319
Practice Address - Country:US
Practice Address - Phone:206-284-2136
Practice Address - Fax:206-284-3559
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice