1003136086 NPI number — DR. JOEL HOWARD FREEDENBERG D.D.S.

Table of content: DR. JOEL HOWARD FREEDENBERG D.D.S. (NPI 1003136086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003136086 NPI number — DR. JOEL HOWARD FREEDENBERG D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEDENBERG
Provider First Name:
JOEL
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003136086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17706 GLOBE THEATRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20832-1675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-5498
Provider Business Mailing Address Fax Number:
301-570-1716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5005 SIGNAL BELL LN
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21029-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-535-8940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7973 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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