Provider Demographics
NPI:1952480436
Name:FRIEDT, MATTHEW P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:P
Last Name:FRIEDT
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 1:2006 FRANKLIN ST SE STE 209
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-533-1723
Mailing Address - Fax:256-533-1750
Practice Address - Street 1:2006 FRANKLIN ST SUITE 209
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-1723
Practice Address - Fax:256-533-1750
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13539876Medicaid
AZ115981Medicaid