Provider Demographics
NPI:1386843449
Name:FREEDMAN, MATTHEW A (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:FREEDMAN
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 1:3020 NW 125TH AVE APT 218
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-6318
Mailing Address - Country:US
Mailing Address - Phone:954-838-9693
Mailing Address - Fax:954-386-8161
Practice Address - Street 1:3020 NW 125TH AVE APT 218
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-6318
Practice Address - Country:US
Practice Address - Phone:954-838-9693
Practice Address - Fax:954-386-8161
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL179661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics