Provider Demographics
NPI:1992908750
Name:FRIEDLANDER, JESSE
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:FRIEDLANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:FRIEDLANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5041 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2079
Mailing Address - Country:US
Mailing Address - Phone:610-520-0363
Mailing Address - Fax:610-520-0363
Practice Address - Street 1:5041 BRITTANY LN
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2079
Practice Address - Country:US
Practice Address - Phone:610-520-0363
Practice Address - Fax:610-520-0363
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019958-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice