Provider Demographics
NPI:1447366604
Name:FREEDLINE, RANDY DENNIS (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:DENNIS
Last Name:FREEDLINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 N OAK HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2844
Mailing Address - Country:US
Mailing Address - Phone:305-932-9202
Mailing Address - Fax:305-932-8448
Practice Address - Street 1:2627 N.E. 203 ST.
Practice Address - Street 2:SUITE 212
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-932-9202
Practice Address - Fax:305-932-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice