Healthcare Provider Details

I. General information

NPI: 1043435043
Provider Name (Legal Business Name): RICHARD MICHAEL FREIMUTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 24TH ST
YUMA AZ
85364-8551
US

IV. Provider business mailing address

120 W 24TH ST
YUMA AZ
85364-8551
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-2106
  • Fax: 928-783-1106
Mailing address:
  • Phone: 928-783-2106
  • Fax: 928-783-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4009
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: