Provider Demographics
NPI:1679906622
Name:FREEMAN, JACQUELYN JEANNE (DDS)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:JEANNE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 W MOORE RD
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8888
Mailing Address - Country:US
Mailing Address - Phone:520-247-7341
Mailing Address - Fax:
Practice Address - Street 1:1460 W MOORE RD
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-8888
Practice Address - Country:US
Practice Address - Phone:520-247-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002020881223G0001X
TX308011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice