Provider Demographics
NPI:1124424338
Name:GERALD Q. FREEMAN JR., DDS LLC
Entity type:Organization
Organization Name:GERALD Q. FREEMAN JR., DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:QUINTON
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-599-3182
Mailing Address - Street 1:12482 WARWICK BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3004
Mailing Address - Country:US
Mailing Address - Phone:757-599-3182
Mailing Address - Fax:
Practice Address - Street 1:12482 WARWICK BLVD
Practice Address - Street 2:STE G
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3004
Practice Address - Country:US
Practice Address - Phone:757-599-3182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty