Provider Demographics
NPI:1730274853
Name:FREEDMAN, SETH P (DDS)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:P
Last Name:FREEDMAN
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 1:16920 MANCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD,
Mailing Address - State:MO
Mailing Address - Zip Code:63040
Mailing Address - Country:US
Mailing Address - Phone:636-458-4999
Mailing Address - Fax:636-458-4222
Practice Address - Street 1:16920 MANCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:WILDWOOD,
Practice Address - State:MO
Practice Address - Zip Code:63040
Practice Address - Country:US
Practice Address - Phone:636-458-4999
Practice Address - Fax:636-458-4222
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001745671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice