Healthcare Provider Details

I. General information

NPI: 1104495308
Provider Name (Legal Business Name): JAMES MATTHEW FREIHOFER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E TAMPA ST
SPRINGFIELD MO
65806-1131
US

IV. Provider business mailing address

13760 LAKERIDGE DR
FISHERS IN
46037-7608
US

V. Phone/Fax

Practice location:
  • Phone: 417-851-1551
  • Fax: 417-865-3479
Mailing address:
  • Phone: 317-588-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12014682A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: