Healthcare Provider Details

I. General information

NPI: 1336159367
Provider Name (Legal Business Name): ROBERT C FREIBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 PITTSFORD PALMYRA RD SUITE 110
FAIRPORT NY
14450-3584
US

IV. Provider business mailing address

6800 PITTSFORD PALMYRA RD SUITE 110
FAIRPORT NY
14450-3584
US

V. Phone/Fax

Practice location:
  • Phone: 585-223-5330
  • Fax: 585-223-7601
Mailing address:
  • Phone: 585-223-5330
  • Fax: 585-223-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number050766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: