Provider Demographics
NPI:1093068736
Name:FREEPORT FAMILY DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:FREEPORT FAMILY DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-235-2600
Mailing Address - Street 1:1768 S. ROSENSTIEL DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6897
Mailing Address - Country:US
Mailing Address - Phone:815-235-2600
Mailing Address - Fax:815-235-9846
Practice Address - Street 1:1768 S. ROSENSTIEL DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6897
Practice Address - Country:US
Practice Address - Phone:815-235-2600
Practice Address - Fax:815-235-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies