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General NPI Number Information
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NPI Number | 1376612101
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Entity Type | Individual
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Provider Name | RANDY FREIJ DDS
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 02/07/2009
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Provider Practice Location Address
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Address Line | 31393 W 13 MILE RD SUITE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2297
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Country | US
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Telephone | 734-474-4703
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Fax | 734-522-0534
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Provider Business Mailing Address
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Address Line | 31393 W 13 MILE RD SUITE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2297
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Country | US
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Telephone | 734-474-4703
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Fax | 734-522-0534
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901018929
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License Number State | MI
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