Provider Demographics
NPI:1336121615
Name:RAMOS, FREDDIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
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:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0777
Mailing Address - Country:US
Mailing Address - Phone:573-708-7600
Mailing Address - Fax:577-231-1474
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAVOIS MILLS
Practice Address - State:MO
Practice Address - Zip Code:65037-6253
Practice Address - Country:US
Practice Address - Phone:877-406-2662
Practice Address - Fax:573-207-2773
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7086122300000X
MO2022047667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100302080AMedicaid
MO1336121615Medicaid
KS1336121615Medicaid