Healthcare Provider Details

I. General information

NPI: 1871237792
Provider Name (Legal Business Name): JOHN FREDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CARDINAL CT STE 320
SAN DIEGO CA
92123-3357
US

IV. Provider business mailing address

66 MEADOW SPRING CT
EAST AMHERST NY
14051-1396
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-8080
  • Fax:
Mailing address:
  • Phone: 716-465-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number112218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: