Jacob Aaron Freeze, DMD
Individual provider Active NPI General Practice Dentistry · Moody Afb, GA
NPI 1053949198 · NPPES record last updated Apr 1, 2022
Key facts
- NPI
- 1053949198
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 61090426 (WA)
- Practice address
- 3278 Mitchell Blvd BLDG 900
Moody Afb, GA 31699-5529 - Phone
- (229) 257-1459
- NPI assigned
- Apr 1, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61090426 | WA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61090426 | WA | Yes |
Addresses
Primary practice location
3278 Mitchell Blvd BLDG 900
Moody Afb, GA 31699-5529
Mailing address
3278 Mitchell Blvd BLDG 900
Moody Afb, GA 31699-1500
Phone (229) 257-3136
Other providers in Moody Afb, GA
- Logan Ryan Featherston
- Adam J Fewox
- Laura Cosima Flumerfelt
- Steven Fogger
- Chun Chung Fong
- Adam K Fry
- Jovanna Omari Wilson Gaines
- Kristina Pauline Gardella
- Austin Thomas Geer
- Cleona Marie Griffin
All providers in Moody Afb, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.