Provider Demographics
NPI:1255439394
Name:FREEMAN, ROURK BARTON (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:ROURK
Middle Name:BARTON
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 SALUDA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-2460
Mailing Address - Country:US
Mailing Address - Phone:864-246-8347
Mailing Address - Fax:864-246-8329
Practice Address - Street 1:736 SALUDA LAKE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-2460
Practice Address - Country:US
Practice Address - Phone:864-246-8347
Practice Address - Fax:864-246-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4054Medicaid