Healthcare Provider Details

I. General information

NPI: 1578010047
Provider Name (Legal Business Name): JESSE FROEHNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/18/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 BOULEVARD DE FRANCE
FPO AA
29902
US

IV. Provider business mailing address

18 7TH AVE
BLUFFTON SC
29910-8702
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-3500
  • Fax:
Mailing address:
  • Phone: 319-939-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number09305
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: