Provider Demographics
NPI:1457019796
Name:FREESE, BRITTANY (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:FREESE
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7387
Mailing Address - Country:US
Mailing Address - Phone:855-944-5437
Mailing Address - Fax:
Practice Address - Street 1:2820 ANCHOR DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-7387
Practice Address - Country:US
Practice Address - Phone:855-944-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014015687124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist