Healthcare Provider Details

I. General information

NPI: 1760452437
Provider Name (Legal Business Name): JAMES EDWARD FREEMAN IV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/07/2023
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 WATERTOWER CIR STE 100
COLCHESTER VT
05446-5801
US

IV. Provider business mailing address

441 WATERTOWER CIR STE 100
COLCHESTER VT
05446-5801
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-9196
  • Fax: 802-862-5769
Mailing address:
  • Phone: 802-862-9196
  • Fax: 802-862-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number016.0084809
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: