Provider Demographics
NPI:1770945032
Name:DBF SURGICAL ASSISTANT
Entity type:Organization
Organization Name:DBF SURGICAL ASSISTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CST, SFA
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVIDETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CST, SFA
Authorized Official - Phone:678-425-4344
Mailing Address - Street 1:1473 ALAMEIN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-2862
Mailing Address - Country:US
Mailing Address - Phone:678-425-4344
Mailing Address - Fax:678-403-0334
Practice Address - Street 1:1473 ALAMEIN DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-2862
Practice Address - Country:US
Practice Address - Phone:678-425-4344
Practice Address - Fax:678-403-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty