1831338680 NPI number — HUMOR DENTAL GROUP OF DR. LAUREN R. FRIEDMAN, DDS

Table of content: (NPI 1831338680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831338680 NPI number — HUMOR DENTAL GROUP OF DR. LAUREN R. FRIEDMAN, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMOR DENTAL GROUP OF DR. LAUREN R. FRIEDMAN, DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. LAUREN R. FRIEDMAN, DDS
Provider Other Organization Name Type Code:
3
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:
1831338680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2355 WESTWOOD BLVD # 718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90064-2109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-418-7788
Provider Business Mailing Address Fax Number:
800-801-8730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2355 WESTWOOD BLVD # 718
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90064-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-418-7788
Provider Business Practice Location Address Fax Number:
800-801-8730
Provider Enumeration Date:
02/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-418-7788

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  26639 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26639 . This is a "DENTAL LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B-26639-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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