Provider Demographics
NPI:1043779390
Name:FREED, ARIELLE ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:ELIZABETH
Last Name:FREED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 OAK GROVE AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3244
Mailing Address - Country:US
Mailing Address - Phone:626-696-9973
Mailing Address - Fax:
Practice Address - Street 1:2615 RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2237
Practice Address - Country:US
Practice Address - Phone:650-282-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1077061223D0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program