Provider Demographics
NPI:1144355108
Name:ROURK B. FREEMAN, DMD,PA
Entity type:Organization
Organization Name:ROURK B. FREEMAN, DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-246-8347
Mailing Address - Street 1:736 SALUDA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-2460
Mailing Address - Country:US
Mailing Address - Phone:864-246-8347
Mailing Address - Fax:
Practice Address - Street 1:736 SALUDA LAKE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-2460
Practice Address - Country:US
Practice Address - Phone:864-246-8347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4054Medicaid
SC4054OtherSTATE LICENSE