Provider Demographics
NPI:1245239458
Name:FRECKELTON, VIRGINIA LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:LEE
Last Name:FRECKELTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DUANE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1614
Mailing Address - Country:US
Mailing Address - Phone:650-366-7781
Mailing Address - Fax:650-368-5582
Practice Address - Street 1:115 DUANE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1614
Practice Address - Country:US
Practice Address - Phone:650-366-7781
Practice Address - Fax:650-368-5582
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31785OtherDENTAL BOARD