Provider Demographics
NPI:1699041996
Name:PHILIP I. FRIEDMAN, D.D.S., P.C.
Entity type:Organization
Organization Name:PHILIP I. FRIEDMAN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAWCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-7693
Mailing Address - Street 1:6803 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2509
Mailing Address - Country:US
Mailing Address - Phone:912-354-7693
Mailing Address - Fax:912-354-8762
Practice Address - Street 1:6803 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2509
Practice Address - Country:US
Practice Address - Phone:912-354-7693
Practice Address - Fax:912-354-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN 0112481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty