Provider Demographics
NPI:1124379920
Name:MICHAEL S. FREEDUS, DDS, PC
Entity Type:Organization
Organization Name:MICHAEL S. FREEDUS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-432-3564
Mailing Address - Street 1:53 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2405
Mailing Address - Country:US
Mailing Address - Phone:607-432-3564
Mailing Address - Fax:607-432-7613
Practice Address - Street 1:53 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2405
Practice Address - Country:US
Practice Address - Phone:607-432-3564
Practice Address - Fax:607-432-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00534354Medicaid