Healthcare Provider Details

I. General information

NPI: 1336121615
Provider Name (Legal Business Name): FREDDIE RAMOS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/08/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST
GRAVOIS MILLS MO
65037-6253
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 877-406-2662
  • Fax: 573-207-2773
Mailing address:
  • Phone: 573-708-7600
  • Fax: 577-231-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7086
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2022047667
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: