MEDICARE: DR. ROSS TYLER FREEMAN D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN21407	FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12011644A	IN

General Provider Information

NPI Number	:	1184919250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS TYLER FREEMAN D.D.S.

Provider Business Mailing Address
First Line	:	8004 SUMMERLIN LAKES DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1817
Country	:	US
Telephone Number	:	239-267-7385
Fax Number	:

Provider Business Practice Location Address
First Line	:	8004 SUMMERLIN LAKES DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1817
Country	:	US
Telephone Number	:	239-267-7385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	08/18/2023

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Directions to “ DR. ROSS TYLER FREEMAN D.D.S.” Practice Location

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