Provider Demographics
NPI:1376057562
Name:FREEMAN MOBILE ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:FREEMAN MOBILE ORTHODONTICS, PLLC
Other - Org Name:SWANKY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:954-816-3956
Mailing Address - Street 1:5201 NE 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3407
Mailing Address - Country:US
Mailing Address - Phone:954-816-3956
Mailing Address - Fax:
Practice Address - Street 1:1825 NE 45TH ST STE A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5157
Practice Address - Country:US
Practice Address - Phone:954-837-8367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty