Provider Demographics
NPI:1912931155
Name:FRIEDLANDER, MARK SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SAMUEL
Last Name:FRIEDLANDER
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 1:1803 BEAVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-2628
Mailing Address - Country:US
Mailing Address - Phone:434-823-7231
Mailing Address - Fax:
Practice Address - Street 1:300 HICKMAN RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3554
Practice Address - Country:US
Practice Address - Phone:434-973-2520
Practice Address - Fax:434-974-9497
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA72771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA385702OtherANTHEM
VA858667OtherUNITED CONCORDIA