Provider Demographics
NPI:1982789244
Name:FRIEDMAN, JODY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:MICHAEL
Last Name:FRIEDMAN
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 1:3144 STATE ROAD 32 E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8730
Mailing Address - Country:US
Mailing Address - Phone:317-867-0757
Mailing Address - Fax:317-867-0756
Practice Address - Street 1:3144 STATE ROAD 32 E
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8730
Practice Address - Country:US
Practice Address - Phone:317-867-0757
Practice Address - Fax:317-867-0756
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010261A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice