Provider Demographics
NPI:1972840460
Name:SCOTT J FRIDRICH DDS PC
Entity Type:Organization
Organization Name:SCOTT J FRIDRICH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF DENTAL SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FRIDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-443-4416
Mailing Address - Street 1:1120 ALPINE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3414
Mailing Address - Country:US
Mailing Address - Phone:303-443-4416
Mailing Address - Fax:
Practice Address - Street 1:1120 ALPINE AVE STE C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3414
Practice Address - Country:US
Practice Address - Phone:303-443-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty