Provider Demographics
NPI:1730104399
Name:FRESHLEY, FRED RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:RONALD
Last Name:FRESHLEY
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 1:300 LOCUST ST
Mailing Address - Street 2:RM 430
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1821
Mailing Address - Country:US
Mailing Address - Phone:330-535-7876
Mailing Address - Fax:330-535-7878
Practice Address - Street 1:300 LOCUST ST
Practice Address - Street 2:RM 430
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1821
Practice Address - Country:US
Practice Address - Phone:330-535-7876
Practice Address - Fax:330-535-7878
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30011093122300000X
OH30 01 1093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0131735Medicaid