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General NPI Number Information
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NPI Number | 1447766100
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Entity Type | Organization
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Legal Business Name | FREED DENTAL PROF. L.L.C.
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 1709 E 10TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57103-1805
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Country | US
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Telephone | 605-261-5709
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Fax |
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Provider Business Mailing Address
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Address Line | 8604 S QUIET OAK CIR
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City | SIOUX FALLS
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State | SD
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Zip | 57108-4138
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Country | US
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Telephone | 605-261-5709
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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. MEGAN JOANN DIAZ-FREED
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Credential | D.D.S.
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Telephone | 605-261-5709
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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 | D1000
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License Number State | SD
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