Provider Demographics
NPI:1639258320
Name:FREEMAN, AARON BLANE (DDS)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:BLANE
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-1003
Mailing Address - Country:US
Mailing Address - Phone:616-374-8053
Mailing Address - Fax:616-374-0731
Practice Address - Street 1:924 4TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1003
Practice Address - Country:US
Practice Address - Phone:616-374-8053
Practice Address - Fax:616-374-0731
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist