Provider Demographics
NPI:1235259771
Name:FREED, GARY W (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:FREED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8142 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2000
Mailing Address - Country:US
Mailing Address - Phone:954-475-1212
Mailing Address - Fax:954-475-1077
Practice Address - Street 1:8142 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2000
Practice Address - Country:US
Practice Address - Phone:954-475-1212
Practice Address - Fax:954-475-1077
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00136301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice