Provider Demographics
NPI:1285201871
Name:FREISE, CLAIRE REBECCA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:REBECCA
Last Name:FREISE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 JEFFCO BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1409
Mailing Address - Country:US
Mailing Address - Phone:636-287-0440
Mailing Address - Fax:
Practice Address - Street 1:849 JEFFCO BLVD # 200
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1409
Practice Address - Country:US
Practice Address - Phone:636-287-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021020347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist