Provider Demographics
NPI:1356686190
Name:FREEDOM MARK DENTAL PA
Entity Type:Organization
Organization Name:FREEDOM MARK DENTAL PA
Other - Org Name:WESTPARK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-283-1205
Mailing Address - Street 1:2275 WESTPARK CT
Mailing Address - Street 2:SUITE #101
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3999
Mailing Address - Country:US
Mailing Address - Phone:817-283-1205
Mailing Address - Fax:
Practice Address - Street 1:2275 WESTPARK CT
Practice Address - Street 2:SUITE #101
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3999
Practice Address - Country:US
Practice Address - Phone:817-283-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty