Provider Demographics
NPI:1053549568
Name:RANDALL K. FREEMAN, DDS
Entity type:Organization
Organization Name:RANDALL K. FREEMAN, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-657-6909
Mailing Address - Street 1:54 WEST MAIN STREET
Mailing Address - Street 2:PO BOX 369
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9231
Mailing Address - Country:US
Mailing Address - Phone:585-657-6909
Mailing Address - Fax:585-657-7016
Practice Address - Street 1:54 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NY
Practice Address - Zip Code:14469-9231
Practice Address - Country:US
Practice Address - Phone:585-657-6909
Practice Address - Fax:585-657-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty