Healthcare Provider Details

I. General information

NPI: 1982868634
Provider Name (Legal Business Name): STEVEN R. FREEMAN DDS PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W TOWN PL STE 21
ST AUGUSTINE FL
32092-3103
US

IV. Provider business mailing address

319 W TOWN PL STE 21
ST AUGUSTINE FL
32092-3103
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-3933
  • Fax:
Mailing address:
  • Phone: 904-940-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17155
License Number StateFL

VIII. Authorized Official

Name: STEVEN RONALD FREEMAN
Title or Position: DENTIST
Credential:
Phone: 904-940-3933