Provider Demographics
NPI:1053330019
Name:FREYMAN, ILYA V (DMD)
Entity Type:Individual
Prefix:
First Name:ILYA
Middle Name:V
Last Name:FREYMAN
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 1:286 E STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5274
Mailing Address - Country:US
Mailing Address - Phone:407-260-0224
Mailing Address - Fax:407-260-6976
Practice Address - Street 1:286 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5274
Practice Address - Country:US
Practice Address - Phone:407-260-0224
Practice Address - Fax:407-260-6976
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00012695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist