Provider Demographics
NPI:1457341455
Name:FREEDMAN, MATTHEW D (DMD, MAGD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4932
Mailing Address - Country:US
Mailing Address - Phone:717-392-8376
Mailing Address - Fax:717-392-8041
Practice Address - Street 1:416 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4932
Practice Address - Country:US
Practice Address - Phone:717-392-8376
Practice Address - Fax:717-392-8041
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028147L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU48113Medicare UPIN