Provider Demographics
NPI:1447766100
Name:FREED DENTAL PROF. L.L.C.
Entity Type:Organization
Organization Name:FREED DENTAL PROF. L.L.C.
Other - Org Name:10TH STREET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:DIAZ-FREED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-261-5709
Mailing Address - Street 1:8604 S QUIET OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-4138
Mailing Address - Country:US
Mailing Address - Phone:605-261-5709
Mailing Address - Fax:
Practice Address - Street 1:1709 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-1805
Practice Address - Country:US
Practice Address - Phone:605-261-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental