Provider Demographics
NPI:1831338680
Name:HUMOR DENTAL GROUP OF DR. LAUREN R. FRIEDMAN, DDS
Entity type:Organization
Organization Name:HUMOR DENTAL GROUP OF DR. LAUREN R. FRIEDMAN, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:D,DS
Authorized Official - Phone:310-418-7788
Mailing Address - Street 1:2355 WESTWOOD BLVD # 718
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2109
Mailing Address - Country:US
Mailing Address - Phone:310-418-7788
Mailing Address - Fax:800-801-8730
Practice Address - Street 1:2355 WESTWOOD BLVD # 718
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2109
Practice Address - Country:US
Practice Address - Phone:310-418-7788
Practice Address - Fax:800-801-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26639OtherDENTAL LICENSE #
CAB-26639-01Medicaid