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General NPI Number Information
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NPI Number | 1619034279
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Entity Type | Individual
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Provider Name | MATTHEW ERIC FREEMAN D.D.S, M.S.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2680 S WHITE RD SUITE 255
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City | SAN JOSE
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State | CA
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Zip | 95148-2074
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Country | US
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Telephone | 408-274-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 5552 BLOSSOM DALE DR
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City | SAN JOSE
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State | CA
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Zip | 95124-6042
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Country | US
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Telephone | 408-358-4185
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 49883
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License Number State | CA
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