Provider Demographics
NPI:1245324953
Name:FREIMUTH, RONALD J
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:FREIMUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12870 STROH RANCH WAY
Mailing Address - Street 2:103
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7706
Mailing Address - Country:US
Mailing Address - Phone:303-840-6543
Mailing Address - Fax:303-840-1896
Practice Address - Street 1:12870 STROH RANCH WAY
Practice Address - Street 2:103
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7408
Practice Address - Country:US
Practice Address - Phone:303-840-6543
Practice Address - Fax:303-840-1896
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO66261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice