Provider Demographics
NPI:1124376397
Name:FREKING, ANGELIQUE RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:RENEE
Last Name:FREKING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WALL STREET
Mailing Address - Street 2:#720
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005
Mailing Address - Country:US
Mailing Address - Phone:212-514-5514
Mailing Address - Fax:212-514-8510
Practice Address - Street 1:15 E 12TH ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4436
Practice Address - Country:US
Practice Address - Phone:720-273-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056261122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist