Provider Demographics
NPI:1710423074
Name:FREEMAN, HORACE AINSLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HORACE
Middle Name:AINSLEY
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 1:3550 TOBAGO LN
Mailing Address - Street 2:APT 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1891
Mailing Address - Country:US
Mailing Address - Phone:813-425-5703
Mailing Address - Fax:
Practice Address - Street 1:2992 WALDORF MARKET PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4874
Practice Address - Country:US
Practice Address - Phone:301-645-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice