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General NPI Number Information
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NPI Number | 1619133923
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Entity Type | Organization
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Legal Business Name | SCOTT FREEMAN, D.M.D., P.A.
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 6363 W EMERALD ST #101
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City | BOISE
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State | ID
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Zip | 83704-8783
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Country | US
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Telephone | 208-377-2150
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Fax | 208-377-3930
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Provider Business Mailing Address
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Address Line | 6363 W EMERALD ST #101
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City | BOISE
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State | ID
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Zip | 83704-8783
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Country | US
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Telephone | 208-377-2150
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Fax | 208-377-3930
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. SCOTT DOUGLAS FREEMAN
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Credential | D.M.D.
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Telephone | 208-377-2150
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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 | 1479 PD
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License Number State | ID
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