Provider Demographics
NPI:1194870071
Name:FREEMAN, GERALD QUINTON JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:QUINTON
Last Name:FREEMAN
Suffix:JR
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 1:12482 WARWICK BLVD
Mailing Address - Street 2:SUITE 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:SUITE 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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist