Provider Demographics
NPI:1245405679
Name:FREYTAG, FREDERICK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:FREYTAG
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 1:205 LINCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9158
Mailing Address - Country:US
Mailing Address - Phone:740-587-7672
Mailing Address - Fax:
Practice Address - Street 1:713 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1616
Practice Address - Country:US
Practice Address - Phone:740-622-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-27
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0319417Medicaid