Healthcare Provider Details

I. General information

NPI: 1043779390
Provider Name (Legal Business Name): ARIELLE ELIZABETH FREED DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 RIVERSIDE BLVD
SACRAMENTO CA
95818-2237
US

IV. Provider business mailing address

510 OAK GROVE AVE APT C
MENLO PARK CA
94025-3244
US

V. Phone/Fax

Practice location:
  • Phone: 650-282-4171
  • Fax:
Mailing address:
  • Phone: 626-696-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number107706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: