Provider Demographics
NPI:1902880875
Name:FRIEDMAN, SIDNEY HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:HAROLD
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 1:10345 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE #150
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5762
Mailing Address - Country:US
Mailing Address - Phone:262-240-9400
Mailing Address - Fax:262-241-5652
Practice Address - Street 1:10345 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE #150
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5762
Practice Address - Country:US
Practice Address - Phone:262-240-9400
Practice Address - Fax:262-241-5652
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001442-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice