Provider Demographics
NPI:1558434365
Name:FREILICH & WOLFROM
Entity type:Organization
Organization Name:FREILICH & WOLFROM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-624-3800
Mailing Address - Street 1:2560 RCA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3338
Mailing Address - Country:US
Mailing Address - Phone:561-624-3800
Mailing Address - Fax:561-624-3649
Practice Address - Street 1:2560 RCA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3338
Practice Address - Country:US
Practice Address - Phone:561-624-3800
Practice Address - Fax:561-624-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN67951223S0112X
FLDN 86381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty