MEDICARE: RANDALL K. FREEMAN, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1053549568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL K. FREEMAN, DDS

Provider Business Mailing Address
First Line	:	54 WEST MAIN STREET
Second Line	:	PO BOX 369
City	:	BLOOMFIELD
State	:	NY
Zip	:	14469-9231
Country	:	US
Telephone Number	:	585-657-6909
Fax Number	:	585-657-7016

Provider Business Practice Location Address
First Line	:	54 WEST MAIN STREET
Second Line	:
City	:	BLOOMFIELD
State	:	NY
Zip	:	14469-9231
Country	:	US
Telephone Number	:	585-657-6909
Fax Number	:	585-657-7016

Authorized Official
Title or Position	:	OFFICE COORDINATOR
Name	:	KATHY L DAILEY
Credential	:
Telephone Number	:	585-657-6909

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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