MEDICARE: DR. RANDALL KARL FREBERG 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	3217	AZ
2	1223G0001X	General Practice Dentistry	033085	CA

General Provider Information

NPI Number	:	1962514265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL KARL FREBERG DDS

Provider Business Mailing Address
First Line	:	1486 PALM ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2938
Country	:	US
Telephone Number	:	805-543-8675
Fax Number	:	805-543-8696

Provider Business Practice Location Address
First Line	:	1486 PALM ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2938
Country	:	US
Telephone Number	:	805-543-8675
Fax Number	:	805-543-8696

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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