Provider Demographics
NPI:1306954177
Name:FREYTAG, MARVIN WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:WAYNE
Last Name:FREYTAG
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 1:103 S KELLY ST
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-2850
Mailing Address - Country:US
Mailing Address - Phone:361-798-2726
Mailing Address - Fax:361-798-2766
Practice Address - Street 1:103 S KELLY ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2850
Practice Address - Country:US
Practice Address - Phone:361-798-2726
Practice Address - Fax:361-798-2766
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice