Provider Demographics
NPI:1265296230
Name:FREIBERG, KELLY LYNN (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:FREIBERG
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 HONEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7649
Mailing Address - Country:US
Mailing Address - Phone:920-379-7148
Mailing Address - Fax:
Practice Address - Street 1:550 CITY CTR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4830
Practice Address - Country:US
Practice Address - Phone:920-731-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5472124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist