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General NPI Number Information
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NPI Number | 1356879720
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Entity Type | Organization
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Legal Business Name | KEVEN FREEMAN DMD PLLC
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 05/30/2017
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Provider Practice Location Address
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Address Line | 616 S 10TH AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4112
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Country | US
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Telephone | 208-454-0473
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Fax |
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Provider Business Mailing Address
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Address Line | 616 S 10TH AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVEN FREEMAN
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Credential | DMD
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Telephone | 801-520-6325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D-4834
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License Number State | ID
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