Provider Demographics
NPI:1972506681
Name:LEE M FRIEDEL, DDS AND ELISE BOLSKI, DDS, LLC
Entity Type:Organization
Organization Name:LEE M FRIEDEL, DDS AND ELISE BOLSKI, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-389-0511
Mailing Address - Street 1:1605 TOWN CENTER CIR
Mailing Address - Street 2:STE B
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3637
Mailing Address - Country:US
Mailing Address - Phone:954-389-0511
Mailing Address - Fax:
Practice Address - Street 1:1605 TOWN CENTER CIR
Practice Address - Street 2:STE B
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3637
Practice Address - Country:US
Practice Address - Phone:954-389-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7855122300000X
FL142611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty