Provider Demographics
NPI:1477511491
Name:FRIEDMAN, KURT E (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:E
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 N. UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4649
Mailing Address - Country:US
Mailing Address - Phone:954-227-4892
Mailing Address - Fax:954-227-4894
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:SUITE 101-102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7809
Practice Address - Country:US
Practice Address - Phone:954-475-9840
Practice Address - Fax:954-370-0500
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00067971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2043705OtherTAX ID
FL074683500Medicaid
FLDN0006797OtherDENTAL LICENSE
FLDN0006797OtherDENTAL LICENSE
FL86584WMedicare ID - Type Unspecified
FLDN0006797OtherDENTAL LICENSE
FL074683500Medicaid
FL21328BMedicare PIN
FL21328Medicare PIN
FLAF7850692OtherDEA #