Healthcare Provider Details

I. General information

NPI: 1922197250
Provider Name (Legal Business Name): DANIEL DERRICK FREEMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2567 APPLING RD
MEMPHIS TN
38133-5099
US

IV. Provider business mailing address

2567 APPLING RD
MEMPHIS TN
38133-5099
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-7337
  • Fax: 301-507-1390
Mailing address:
  • Phone: 901-383-7337
  • Fax: 301-507-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDD7767
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: