Provider Demographics
NPI:1952593360
Name:FRIEDMAN, JENNIFER LEAH HENDRICKS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEAH HENDRICKS
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LEAH
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2800 JACKSON BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3477
Mailing Address - Country:US
Mailing Address - Phone:605-343-0711
Mailing Address - Fax:
Practice Address - Street 1:2800 JACKSON BLVD STE 9
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3477
Practice Address - Country:US
Practice Address - Phone:605-343-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019656122300000X
SDD0964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist