Provider Demographics
NPI:1336159367
Name:FREIBERG, ROBERT C (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:FREIBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3584
Mailing Address - Country:US
Mailing Address - Phone:585-223-5330
Mailing Address - Fax:585-223-7601
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3584
Practice Address - Country:US
Practice Address - Phone:585-223-5330
Practice Address - Fax:585-223-7601
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70586RFOtherBLUE SHIELD PROVIDER #