Provider Demographics
NPI:1790339067
Name:FREIDENBERG, JULIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:FREIDENBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 FOUNTAIN AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4178
Mailing Address - Country:US
Mailing Address - Phone:206-335-4218
Mailing Address - Fax:
Practice Address - Street 1:4165 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4418
Practice Address - Country:US
Practice Address - Phone:323-331-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist