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General NPI Number Information
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NPI Number | 1124424338
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Entity Type | Organization
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Legal Business Name | GERALD Q. FREEMAN JR., DDS LLC
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Dates
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Enumeration Date | 11/15/2014
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Last Update Date | 11/15/2014
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Provider Practice Location Address
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Address Line | 12482 WARWICK BLVD STE G
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3004
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Country | US
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Telephone | 757-599-3182
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Fax |
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Provider Business Mailing Address
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Address Line | 12482 WARWICK BLVD STE G
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3004
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Country | US
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Telephone | 757-599-3182
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GERALD QUINTON FREEMAN JR.
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Credential | DDS
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Telephone | 757-599-3182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5782
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License Number State | VA
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