MEDICARE: ROBERT A FREMEAU DMD

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	1223P0300X	Periodontics	02-0342066	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588669477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A FREMEAU DMD

Provider Business Mailing Address
First Line	:	17 RIVER FRONT DR
Second Line	:	UNIT 9
City	:	MANCHESTER
State	:	NH
Zip	:	03102-3264
Country	:	US
Telephone Number	:	603-668-6356
Fax Number	:	603-628-1998

Provider Business Practice Location Address
First Line	:	30 CANTON ST
Second Line	:	STE 12
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3524
Country	:	US
Telephone Number	:	603-668-6434
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/30/2010

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