Provider Demographics
NPI:1609094416
Name:FREYTAG DENTAL
Entity Type:Organization
Organization Name:FREYTAG DENTAL
Other - Org Name:WALBRIDGE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FREYTAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-666-1776
Mailing Address - Street 1:403 N MAIN ST
Mailing Address - Street 2:P.O. BOX 548
Mailing Address - City:WALBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43465-1018
Mailing Address - Country:US
Mailing Address - Phone:419-666-1776
Mailing Address - Fax:419-666-7578
Practice Address - Street 1:403 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43465-1018
Practice Address - Country:US
Practice Address - Phone:419-666-1776
Practice Address - Fax:419-666-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty