Provider Demographics
NPI:1043343130
Name:KENNETH F FREER DDS INC
Entity type:Organization
Organization Name:KENNETH F FREER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:FREER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-643-2307
Mailing Address - Street 1:15 ROTARY WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8475
Mailing Address - Country:US
Mailing Address - Phone:707-643-2307
Mailing Address - Fax:707-643-7208
Practice Address - Street 1:15 ROTARY WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8475
Practice Address - Country:US
Practice Address - Phone:707-643-2307
Practice Address - Fax:707-643-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty