Healthcare Provider Details

I. General information

NPI: 1144218173
Provider Name (Legal Business Name): MICHAEL ROBERT FREISCHEL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SAINT PETER ST SUITE 260
SAINT PAUL MN
55102-1514
US

IV. Provider business mailing address

350 SAINT PETER ST SUITE 260
SAINT PAUL MN
55102-1514
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-8457
  • Fax: 651-292-0313
Mailing address:
  • Phone: 651-292-8457
  • Fax: 651-292-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9097
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: