Provider Demographics
NPI:1881751832
Name:FREIBERG, CARMEN MARA (DDS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARA
Last Name:FREIBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33493 DEL OBISPO ST
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1502
Mailing Address - Country:US
Mailing Address - Phone:949-496-6413
Mailing Address - Fax:949-496-6445
Practice Address - Street 1:33493 DEL OBISPO ST
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1502
Practice Address - Country:US
Practice Address - Phone:949-496-6413
Practice Address - Fax:949-496-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice