Provider Demographics
NPI:1124586300
Name:FREILICH, JACOB E (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:E
Last Name:FREILICH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7951 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3717
Mailing Address - Country:US
Mailing Address - Phone:646-494-3331
Mailing Address - Fax:
Practice Address - Street 1:111 N HWY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5901
Practice Address - Country:US
Practice Address - Phone:314-408-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200084111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics