Provider Demographics
NPI:1245392836
Name:FREEMAN, RANDALL K (DDS)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:K
Last Name:FREEMAN
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 1:126 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564
Mailing Address - Country:US
Mailing Address - Phone:585-924-2160
Mailing Address - Fax:585-924-1875
Practice Address - Street 1:126 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-924-2160
Practice Address - Fax:585-924-1875
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038100-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice