Healthcare Provider Details

I. General information

NPI: 1609262815
Provider Name (Legal Business Name): ROBERT FREMONT D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4527 FANUEL ST
SAN DIEGO CA
92109-2904
US

IV. Provider business mailing address

4527 FANUEL ST
SAN DIEGO CA
92109-2904
US

V. Phone/Fax

Practice location:
  • Phone: 858-272-2222
  • Fax: 858-272-2414
Mailing address:
  • Phone: 858-272-2222
  • Fax: 858-272-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: