Provider Demographics
NPI:1205810686
Name:FREEMAN, VENITA C (DDS)
Entity type:Individual
Prefix:DR
First Name:VENITA
Middle Name:C
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VENITA
Other - Middle Name:C
Other - Last Name:FREEMAN MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:920 DANNON VIEW
Mailing Address - Street 2:SUITE 3102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2158
Mailing Address - Country:US
Mailing Address - Phone:404-349-7646
Mailing Address - Fax:404-349-7647
Practice Address - Street 1:920 DANNON VIEW
Practice Address - Street 2:SUITE 3102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2158
Practice Address - Country:US
Practice Address - Phone:404-349-7646
Practice Address - Fax:404-349-7647
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62311223P0221X
GADN0134431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ886567Medicaid