Jody Freytag, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21562 Issued in OH

Practice address

403 N Main St
Walbridge, OH 43465-1018

Phone

(419) 666-1776

NPI assigned

Apr 19, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Freytag Dental

  dba Walbridge Dental Associates

  • General Practice Dentistry
  • Walbridge, OH
  • NPI 1609094416
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336366889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "476 SYCAMORE LN",
            "city": "WATERVILLE",
            "state": "OH",
            "postal_code": "435661252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 N MAIN ST",
            "city": "WALBRIDGE",
            "state": "OH",
            "postal_code": "434651018",
            "telephone_number": "419-666-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREYTAG",
        "first_name": "JODY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "21562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2636651",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica L. Davenport, LPN
• Destiny Healthcare
• Erin Duprae, OTR/L
• Mary Everly
• Freytag Dental (Walbridge Dental Associates)
• Matthew David Freytag, D.D.S.
• Ryan Robert Gutzky, MHA, ATC, AT
• Patricia Ann Hartman
• Hayle Hereford
• Christopher Shawn Hughes

• General Practice Dentistry in Walbridge, OH
• Providers in Walbridge, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.