Provider Demographics
NPI:1700977691
Name:FRIEDMAN, THOMAS G (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:FRIEDMAN
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 1:1047 THORNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701
Mailing Address - Country:US
Mailing Address - Phone:319-223-5016
Mailing Address - Fax:319-232-4799
Practice Address - Street 1:1047 THORNDALE AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-223-5016
Practice Address - Fax:319-232-4799
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0002949Medicaid