Provider Demographics
NPI:1871617852
Name:FRIEDMAN, VITALY (DDS)
Entity type:Individual
Prefix:DR
First Name:VITALY
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 KING GEORGE ROAD
Mailing Address - Street 2:#201
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:908-604-5959
Mailing Address - Fax:908-604-8822
Practice Address - Street 1:413 KING GEORGE ROAD
Practice Address - Street 2:#201
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920
Practice Address - Country:US
Practice Address - Phone:908-604-5959
Practice Address - Fax:908-604-8822
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ217721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice