Provider Demographics
NPI:1235147778
Name:FRIEDMAN, GREGORY LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LYNN
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 SCRIPPS POWAY PARKWAY #K
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-547-0070
Mailing Address - Fax:858-635-3125
Practice Address - Street 1:114 W NEIDER AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9300
Practice Address - Country:US
Practice Address - Phone:208-682-3567
Practice Address - Fax:208-667-4551
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37417122300000X
IDD-55941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist