Healthcare Provider Details

I. General information

NPI: 1174600464
Provider Name (Legal Business Name): MARK A. FREEMAN JEFFREY A. SHORT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 1511
SEATTLE WA
98101-1749
US

IV. Provider business mailing address

509 OLIVE WAY STE 1511
SEATTLE WA
98101-1749
US

V. Phone/Fax

Practice location:
  • Phone: 206-621-9730
  • Fax: 206-621-7053
Mailing address:
  • Phone: 206-621-9730
  • Fax: 206-621-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MARK A FREEMAN
Title or Position: OWNER
Credential: D.D.S, M.S.D.
Phone: 206-621-9730