Provider Demographics
NPI:1154328201
Name:FREEBURG, MARVIN KIRK (D,D,S,)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:KIRK
Last Name:FREEBURG
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 STONE BROOKE RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-2900
Mailing Address - Country:US
Mailing Address - Phone:515-232-5353
Mailing Address - Fax:
Practice Address - Street 1:137 LYNN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7126
Practice Address - Country:US
Practice Address - Phone:515-292-7262
Practice Address - Fax:515-292-7270
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA58911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice