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General NPI Number Information
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NPI Number | 1447366604
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Entity Type | Individual
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Provider Name | RANDY DENNIS FREEDLINE DDS.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2627 N.E. 203 ST. SUITE 212
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City | AVENTURA
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State | FL
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Zip | 33180
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Country | US
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Telephone | 305-932-9202
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Fax | 305-932-8448
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Provider Business Mailing Address
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Address Line | 1948 N OAK HAVEN CIR
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City | MIAMI
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State | FL
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Zip | 33179-2844
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Country | US
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Telephone | 305-932-9202
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Fax | 305-932-8448
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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 | 9103
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License Number State | FL
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