Provider Demographics
NPI:1295821650
Name:FREELAND, THEODORE DOUGLAS (DDS MS PC)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:DOUGLAS
Last Name:FREELAND
Suffix:
Gender:M
Credentials:DDS MS PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:801 EAST M 32
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
Mailing Address - Country:US
Mailing Address - Phone:989-732-7539
Mailing Address - Fax:989-732-9316
Practice Address - Street 1:801 EAST M 32
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-732-7539
Practice Address - Fax:989-732-9316
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9938122300000X
MI7551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics