MEDICARE: AARON BLANE 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	122300000X	Dentist	2901015676	MI

General Provider Information

NPI Number	:	1639258320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON BLANE FREEMAN D.D.S

Provider Business Mailing Address
First Line	:	924 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1003
Country	:	US
Telephone Number	:	616-374-8053
Fax Number	:	616-374-0731

Provider Business Practice Location Address
First Line	:	924 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1003
Country	:	US
Telephone Number	:	616-374-8053
Fax Number	:	616-374-0731

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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