Provider Demographics
NPI:1447429238
Name:T. J. FREUND DDS, P.C.
Entity Type:Organization
Organization Name:T. J. FREUND DDS, P.C.
Other - Org Name:CHILLICOTHE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-274-3820
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-0170
Mailing Address - Country:US
Mailing Address - Phone:309-274-3820
Mailing Address - Fax:309-274-6088
Practice Address - Street 1:1008 N. 4TH ST.
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523
Practice Address - Country:US
Practice Address - Phone:309-274-3820
Practice Address - Fax:309-274-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1001904OtherDORAL DENTAL