Provider Demographics
NPI:1811339427
Name:FREEDMAN, IRA (DMD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 PINES BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6415
Mailing Address - Country:US
Mailing Address - Phone:954-432-7025
Mailing Address - Fax:954-432-7613
Practice Address - Street 1:9050 PINES BLVD STE 420
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6415
Practice Address - Country:US
Practice Address - Phone:954-432-7025
Practice Address - Fax:954-432-7613
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics