Provider Demographics
NPI:1811216062
Name:FRIDMAN DENTAL CARE
Entity Type:Organization
Organization Name:FRIDMAN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTSADZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-901-9817
Mailing Address - Street 1:1707 W PASSYUNK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3830
Mailing Address - Country:US
Mailing Address - Phone:215-271-7259
Mailing Address - Fax:215-271-7224
Practice Address - Street 1:1707 W PASSYUNK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3830
Practice Address - Country:US
Practice Address - Phone:215-271-7259
Practice Address - Fax:215-271-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031318-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty