Provider Demographics
NPI:1447478953
Name:FREEPORT DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:FREEPORT DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GOOLD
Authorized Official - Last Name:STROUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-729-7788
Mailing Address - Street 1:46 MALLETT DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1313
Mailing Address - Country:US
Mailing Address - Phone:207-865-3934
Mailing Address - Fax:207-865-4590
Practice Address - Street 1:46 MALLETT DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1313
Practice Address - Country:US
Practice Address - Phone:207-865-3934
Practice Address - Fax:207-865-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental