Healthcare Provider Details

I. General information

NPI: 1790926673
Provider Name (Legal Business Name): DAVID C. FREEMAN, DDS, MS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 HERNDON AVE SUITE 101
CLOVIS CA
93611-6303
US

IV. Provider business mailing address

3520 BLOOMFIELD LN
CLOVIS CA
93619-5054
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number52983
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID FREEMAN
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 559-840-5555