1043313596 NPI number — DR. CHARLES ELLIOTT FRIEDMAN DDS MS

Table of content: DR. CHARLES ELLIOTT FRIEDMAN DDS MS (NPI 1043313596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043313596 NPI number — DR. CHARLES ELLIOTT FRIEDMAN DDS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
CHARLES
Provider Middle Name:
ELLIOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043313596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 CARTERET STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUFORT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29902-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-525-1334
Provider Business Mailing Address Fax Number:
843-986-9162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 CARTERET STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29902-5513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-525-1334
Provider Business Practice Location Address Fax Number:
843-986-9162
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  2265 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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