Provider Demographics
NPI:1053441717
Name:FREILICH, ROGER E (DMD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:E
Last Name:FREILICH
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 1:2560 RCA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3338
Mailing Address - Country:US
Mailing Address - Phone:561-624-3800
Mailing Address - Fax:561-624-3649
Practice Address - Street 1:2560 RCA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3338
Practice Address - Country:US
Practice Address - Phone:561-622-9065
Practice Address - Fax:561-622-9081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2050698OtherTAX ID#
FL85537Medicare PIN
FL59-2050698OtherTAX ID#