Provider Demographics
NPI:1528558491
Name:FRELS ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:FRELS ORTHODONTICS PLLC
Other - Org Name:LESLIE K. FRELS, D.D.S., M.S.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-578-0326
Mailing Address - Street 1:203 KERH BLVD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1218
Mailing Address - Country:US
Mailing Address - Phone:361-578-0326
Mailing Address - Fax:
Practice Address - Street 1:203 KERH BLVD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1218
Practice Address - Country:US
Practice Address - Phone:361-578-0326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty