Organization
MICHAEL L. FREID
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL L FREID DDS (PRESIDENT)
(574) 232-4868
Entity
Organization
Contact information
Practice address
225 N NOTRE DAME AVE, SOUTH BEND, IN 46617-2839
(574) 232-4868
(574) 232-4869
Mailing address
225 N NOTRE DAME AVE, SOUTH BEND, IN 46617-2839
(574) 232-4868
(574) 232-4869
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12006859A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100220550
—
IN
Enumeration date
09/26/2006
Last updated
06/18/2008
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