Provider Demographics
NPI:1275784605
Name:DIAZ-FREED, MEGAN JOANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:JOANN
Last Name:DIAZ-FREED
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:PSC 557
Mailing Address - Street 2:BOX 1336
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-0379
Mailing Address - Country:US
Mailing Address - Phone:0803-314-6578
Mailing Address - Fax:
Practice Address - Street 1:205 S WEBSTER ST
Practice Address - Street 2:
Practice Address - City:CALMAR
Practice Address - State:IA
Practice Address - Zip Code:52132-0818
Practice Address - Country:US
Practice Address - Phone:563-562-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist