MEDICARE: RICHARD D FREIBOTH 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	1223G0001X	General Practice Dentistry	DE00006278	WA

General Provider Information

NPI Number	:	1447273032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD D FREIBOTH DDS

Provider Business Mailing Address
First Line	:	1600 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-871-0028
Fax Number	:	360-871-0135

Provider Business Practice Location Address
First Line	:	1600 WOODRIDGE DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3818
Country	:	US
Telephone Number	:	360-871-0028
Fax Number	:	360-871-0135

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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