Provider Demographics
NPI:1992824684
Name:FREUDENFELD, JACK L JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:L
Last Name:FREUDENFELD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8325 WALNUT HILL LN
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4208
Mailing Address - Country:US
Mailing Address - Phone:214-363-1406
Mailing Address - Fax:214-696-3918
Practice Address - Street 1:8325 WALNUT HILL LN
Practice Address - Street 2:SUITE 215
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4208
Practice Address - Country:US
Practice Address - Phone:214-363-1406
Practice Address - Fax:214-696-3918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice