Provider Demographics
NPI:1003019506
Name:GORDON A FREED BARBARA W FREED
Entity Type:Organization
Organization Name:GORDON A FREED BARBARA W FREED
Other - Org Name:NEWMARKET DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-549-3608
Mailing Address - Street 1:28 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2243
Mailing Address - Country:US
Mailing Address - Phone:413-549-3608
Mailing Address - Fax:413-549-5206
Practice Address - Street 1:28 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2243
Practice Address - Country:US
Practice Address - Phone:413-549-3608
Practice Address - Fax:413-549-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1275664922Medicare UPIN
MA1720162589Medicare UPIN