Healthcare Provider Details

I. General information

NPI: 1467074716
Provider Name (Legal Business Name): CAMERON FREELOVE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2020
Last Update Date: 05/12/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 SE 208TH ST
KENT WA
98031-4009
US

IV. Provider business mailing address

23955 SE 40TH PL
SAMMAMISH WA
98029-7569
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-7331
  • Fax:
Mailing address:
  • Phone: 916-384-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number61037790
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: