Provider Demographics
NPI:1154431427
Name:FREEMAN, KIM (MA DMD MS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MA DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N DIXIE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-297-0633
Mailing Address - Fax:
Practice Address - Street 1:115 N DIXIE DR
Practice Address - Street 2:STE 200
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics