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NPI Code Detail

MEDICARE: CHRIS DIAZ-FREED DENTAL PROF LLC

MEDICARE: CHRIS DIAZ-FREED DENTAL PROF LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD1004SD

General Provider Information

NPI Number : 1619412384
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRIS DIAZ-FREED DENTAL PROF LLC
Provider Business Mailing Address
First Line : 1110 W 5TH ST
Second Line :
City : CANTON
State : SD
Zip : 57013-1543
Country : US
Telephone Number : 605-987-2721
Fax Number :
Provider Business Practice Location Address
First Line : 1110 W 5TH ST
Second Line :
City : CANTON
State : SD
Zip : 57013-1543
Country : US
Telephone Number : 605-987-2721
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. CHRIS J DIAZ-FREED
Credential : DDS
Telephone Number : 605-987-2721
Provider Enumeration Date : 01/04/2017
Last Update Date : 01/04/2017

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Directions to “CHRIS DIAZ-FREED DENTAL PROF LLC ” Practice Location

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