Provider Demographics
NPI:1720611700
Name:FREEBORN, KAREN (PHDHP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FREEBORN
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:HYNDMAN
Mailing Address - State:PA
Mailing Address - Zip Code:15545-0706
Mailing Address - Country:US
Mailing Address - Phone:814-842-3206
Mailing Address - Fax:814-842-3746
Practice Address - Street 1:144 5TH AVE
Practice Address - Street 2:
Practice Address - City:HYNDMAN
Practice Address - State:PA
Practice Address - Zip Code:15545-7379
Practice Address - Country:US
Practice Address - Phone:814-842-3206
Practice Address - Fax:814-842-3746
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000571124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist