Provider Demographics
NPI:1831236231
Name:FREED, JONATHAN (DDS,PA)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:FREED
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E LAS OLAS BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-4226
Mailing Address - Country:US
Mailing Address - Phone:954-524-6595
Mailing Address - Fax:954-524-0561
Practice Address - Street 1:401 E LAS OLAS BLVD STE 140
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-4226
Practice Address - Country:US
Practice Address - Phone:954-524-6595
Practice Address - Fax:954-524-0561
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDN167171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice