MEDICARE: DR. VIRGINIA LEE FRECKELTON 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	31785	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31785	OTHER	CA	DENTAL BOARD

General Provider Information

NPI Number	:	1245239458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA LEE FRECKELTON DDS

Provider Business Mailing Address
First Line	:	115 DUANE ST
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1614
Country	:	US
Telephone Number	:	650-366-7781
Fax Number	:	650-368-5582

Provider Business Practice Location Address
First Line	:	115 DUANE ST
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1614
Country	:	US
Telephone Number	:	650-366-7781
Fax Number	:	650-368-5582

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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