Provider Demographics
NPI:1801013339
Name:SILVER LAKES DENTAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SILVER LAKES DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MARLOWE
Authorized Official - Last Name:FRIEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-435-2999
Mailing Address - Street 1:17792 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3923
Mailing Address - Country:US
Mailing Address - Phone:954-435-2999
Mailing Address - Fax:954-435-0011
Practice Address - Street 1:17792 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3923
Practice Address - Country:US
Practice Address - Phone:954-435-2999
Practice Address - Fax:954-435-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN119761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty