Provider Demographics
NPI:1952817520
Name:KELLY R FREEMAN DDS PC
Entity Type:Organization
Organization Name:KELLY R FREEMAN DDS PC
Other - Org Name:LONE TREE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-790-0234
Mailing Address - Street 1:10455 PARK MEADOWS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5307
Mailing Address - Country:US
Mailing Address - Phone:303-790-0234
Mailing Address - Fax:303-768-8644
Practice Address - Street 1:10455 PARK MEADOWS DR STE 101
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5307
Practice Address - Country:US
Practice Address - Phone:303-790-0234
Practice Address - Fax:303-768-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9957261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental