Healthcare Provider Details

I. General information

NPI: 1619034279
Provider Name (Legal Business Name): MATTHEW ERIC FREEMAN D.D.S, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S WHITE RD SUITE 255
SAN JOSE CA
95148-2074
US

IV. Provider business mailing address

5552 BLOSSOM DALE DR
SAN JOSE CA
95124-6042
US

V. Phone/Fax

Practice location:
  • Phone: 408-274-6111
  • Fax:
Mailing address:
  • Phone: 408-358-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number49883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: