Provider Demographics
NPI:1588669477
Name:FREMEAU, ROBERT A (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:FREMEAU
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 1:17 RIVER FRONT DR
Mailing Address - Street 2:UNIT 9
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3264
Mailing Address - Country:US
Mailing Address - Phone:603-668-6356
Mailing Address - Fax:603-628-1998
Practice Address - Street 1:30 CANTON ST
Practice Address - Street 2:STE 12
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3524
Practice Address - Country:US
Practice Address - Phone:603-668-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02-03420661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1588669477Medicaid