Provider Demographics
NPI:1801920764
Name:SIDNEY H. FRIEDMAN, DDS, SC
Entity type:Organization
Organization Name:SIDNEY H. FRIEDMAN, DDS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:D,D,S,
Authorized Official - Phone:262-240-9400
Mailing Address - Street 1:10345 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE #150
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5762
Mailing Address - Country:US
Mailing Address - Phone:262-240-9400
Mailing Address - Fax:262-241-5652
Practice Address - Street 1:10345 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE #150
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5762
Practice Address - Country:US
Practice Address - Phone:262-240-9400
Practice Address - Fax:262-241-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001442-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty