Provider Demographics
NPI:1861412900
Name:FRIEDENBERG, CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:FRIEDENBERG
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 1:4609 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-5803
Mailing Address - Country:US
Mailing Address - Phone:215-744-7161
Mailing Address - Fax:215-744-7456
Practice Address - Street 1:4609 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5803
Practice Address - Country:US
Practice Address - Phone:215-744-7161
Practice Address - Fax:215-744-7456
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO22865L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008592710001Medicaid