Provider Demographics
NPI:1619034279
Name:FREEMAN, MATTHEW ERIC (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ERIC
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5552 BLOSSOM DALE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6042
Mailing Address - Country:US
Mailing Address - Phone:408-358-4185
Mailing Address - Fax:
Practice Address - Street 1:2680 S WHITE RD
Practice Address - Street 2:SUITE 255
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2074
Practice Address - Country:US
Practice Address - Phone:408-274-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics