MEDICARE: ROBERT FREMONT 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	122300000X	Dentist	33457	CA

General Provider Information

NPI Number	:	1609262815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT FREMONT D.D.S

Provider Business Mailing Address
First Line	:	4527 FANUEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2904
Country	:	US
Telephone Number	:	858-272-2222
Fax Number	:	858-272-2414

Provider Business Practice Location Address
First Line	:	4527 FANUEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2904
Country	:	US
Telephone Number	:	858-272-2222
Fax Number	:	858-272-2414

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

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	04/14/2015

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