Provider Demographics
NPI:1225204670
Name:DEIRDRE FROEHLICH DMD LLC
Entity Type:Organization
Organization Name:DEIRDRE FROEHLICH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FROEHLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, LLC
Authorized Official - Phone:503-282-3884
Mailing Address - Street 1:2824 NE WASCO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1772
Mailing Address - Country:US
Mailing Address - Phone:503-282-3884
Mailing Address - Fax:503-282-3893
Practice Address - Street 1:2824 NE WASCO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1772
Practice Address - Country:US
Practice Address - Phone:503-282-3884
Practice Address - Fax:503-282-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6065261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6065OtherGENERAL DENTIST