# FREMONT DENTAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fremont Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093465361
- **Authorized official:** VICENTA REYES (LEAD OF CREDENTIALING)
- **Authorized official phone:** (972) 869-3789

## Contact information

- **Practice address:** 1435 E 23RD ST, FREMONT, NE 68025-2433
- **Practice address phone:** (402) 727-9100
- **Mailing address:** 1435 E 23RD ST, FREMONT, NE 68025-2433
- **Mailing address phone:** (402) 727-9100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/28/2022
- **Last updated:** 03/28/2022