Healthcare Provider Details

I. General information

NPI: 1467538819
Provider Name (Legal Business Name): DENNIS MERTON FREEMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32280 5 MILE RD
LIVONIA MI
48154-6112
US

IV. Provider business mailing address

6735 TORYBROOKE CIR
WEST BLOOMFIELD MI
48323-2164
US

V. Phone/Fax

Practice location:
  • Phone: 734-425-7010
  • Fax: 734-425-9159
Mailing address:
  • Phone: 248-681-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0007840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: