Healthcare Provider Details

I. General information

NPI: 1639258320
Provider Name (Legal Business Name): AARON BLANE FREEMAN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 4TH AVE
LAKE ODESSA MI
48849-1003
US

IV. Provider business mailing address

924 4TH AVE
LAKE ODESSA MI
48849-1003
US

V. Phone/Fax

Practice location:
  • Phone: 616-374-8053
  • Fax: 616-374-0731
Mailing address:
  • Phone: 616-374-8053
  • Fax: 616-374-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901015676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: