Keven Freeman DMD PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D-4834 Issued in ID

Legal business name

KEVEN FREEMAN DMD PLLC

Practice address

616 S 10TH Ave
Caldwell, ID 83605-4112

Phone

(208) 454-0473

NPI assigned

May 30, 2017

Organization subpart

No

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

Authorized official

Name

Keven Freeman, DMD

Title

Owner

Phone

(801) 520-6325

Specialties & licenses 1

Addresses

Other names 1

• Crystal Canyon Family Dental Doing business as

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496102400000",
    "number": "1356879720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 S 10TH AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 S 10TH AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054112",
            "telephone_number": "208-454-0473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVEN FREEMAN DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-30",
        "last_updated": "2017-05-30",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "KEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-520-6325",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-4834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Canyon Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melody Keller, ND
• Merle L. Keller III, MD
• Tatiana Marie Kennedy
• Colt Kennington
• Randon Kessinger
• Kevin Cotter Odpa
• Mark Keylor, LMSW
• Leila Khaddour, MD
• Kimberly Drewrey, Aprn, NP-C
• L. Mark Kimsey, M.D.

• Dental Clinic/Center in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.