=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053589861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONN B FREEMAN DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2008
-----------------------------------------------------
Last Update Date | 02/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3518 WADE AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-832-6665
-----------------------------------------------------
Fax | 919-832-6998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3518 WADE AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-832-6665
-----------------------------------------------------
Fax | 919-832-6998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DONN B FREEMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 919-832-6665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3877
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------