Provider Demographics
NPI:1225783194
Name:FREEDOM DENTAL PLLC
Entity Type:Organization
Organization Name:FREEDOM DENTAL PLLC
Other - Org Name:VALOR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MERKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-372-4833
Mailing Address - Street 1:17074 FM 156 S
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-8704
Mailing Address - Country:US
Mailing Address - Phone:214-254-3763
Mailing Address - Fax:
Practice Address - Street 1:17074 FM 156
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247
Practice Address - Country:US
Practice Address - Phone:940-441-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental