Provider Demographics
NPI:1033207097
Name:FREEMAN, PHILLIP NEAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:NEAL
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 SPYGLASS PARK LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-1453
Mailing Address - Country:US
Mailing Address - Phone:713-398-4822
Mailing Address - Fax:
Practice Address - Street 1:4179 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6852
Practice Address - Country:US
Practice Address - Phone:409-227-1653
Practice Address - Fax:409-899-4868
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9851174400000X
TX261731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15755Medicare UPIN
TX00A30UMedicare ID - Type Unspecified