Provider Demographics
NPI:1649325317
Name:FREEMAN, JOHN P (MD DDS PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 SOUTH FRY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:281-599-9445
Mailing Address - Fax:281-599-9455
Practice Address - Street 1:705 SOUTH FRY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-599-9445
Practice Address - Fax:281-599-9455
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXTXBL1046204E00000X
TXTD20047204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81020Medicare UPIN