Provider Demographics
NPI:1831194687
Name:FRIEDRICH, MARK WARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WARREN
Last Name:FRIEDRICH
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 1:7700 CAT HOLLOW DR STE 208
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5799
Mailing Address - Country:US
Mailing Address - Phone:512-255-4229
Mailing Address - Fax:512-255-7263
Practice Address - Street 1:7700 CAT HOLLOW DR STE 208
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5799
Practice Address - Country:US
Practice Address - Phone:512-255-4229
Practice Address - Fax:512-255-7263
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-04-16
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TX143021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice