Provider Demographics
NPI:1982868634
Name:STEVEN R. FREEMAN DDS PL
Entity Type:Organization
Organization Name:STEVEN R. FREEMAN DDS PL
Other - Org Name:ELITE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-940-3933
Mailing Address - Street 1:319 W TOWN PL STE 21
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3103
Mailing Address - Country:US
Mailing Address - Phone:904-940-3933
Mailing Address - Fax:
Practice Address - Street 1:319 W TOWN PL STE 21
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3103
Practice Address - Country:US
Practice Address - Phone:904-940-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty