Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2265 | SC |
NPI | 1043313596 |
---|---|
Provider Name | Dr. Charles Elliott Friedman |
First Address | Beaufort, SC 29902-5513 |
Second Address | Beaufort, SC 29902-5513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |