Provider Demographics
NPI:1831637792
Name:FREEDMAN ORTHODONTICS
Entity Type:Organization
Organization Name:FREEDMAN ORTHODONTICS
Other - Org Name:VILLAGE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-427-4126
Mailing Address - Street 1:9870 AUTRY FALLS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8007
Mailing Address - Country:US
Mailing Address - Phone:404-427-4126
Mailing Address - Fax:
Practice Address - Street 1:5488 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:STE 8
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4161
Practice Address - Country:US
Practice Address - Phone:678-745-5388
Practice Address - Fax:678-745-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty