Provider Demographics
NPI:1649322736
Name:SPATER FREEDMAN, SHIRLEY ANN (DMD MPH)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:SPATER FREEDMAN
Suffix:
Gender:F
Credentials:DMD MPH
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:SPATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD MPH
Mailing Address - Street 1:593 EDDY STREET
Mailing Address - Street 2:SAMUELS SINCLAIR DENTAL CENTER AT RIH
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-5995
Mailing Address - Fax:401-444-3494
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:SAMUELS SINCLAIR DENTAL CENTER AT RIH
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5995
Practice Address - Fax:401-444-3494
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN025211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISS13671Medicaid
RISS13671Medicaid