Individual provider Active NPI

Frank B Freeman, DMD

  • Dentist
  • Liberty, MS
National Provider Identifier
1417934357
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2544 90 Issued in MS
Practice address
102 West Freedom
Liberty, MS 39645-0511
Phone
(601) 657-4326
Fax
(601) 657-8867
NPI assigned
Dec 30, 2005
Last updated
May 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2544 90 MS Primary

Addresses

Primary practice location

102 West Freedom
Liberty, MS 39645-0511

Mailing address

102 West Freedom Drive
Liberty, MS 39645-0511
Phone (601) 657-4326

Other identifiers 1

IdentifierTypeStateIssuer
04781825MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20160122000229 MS Order and Referring Only - DentistPractitioner - Dentist 6305149535

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2544 90MSMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1417934357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WEST FREEDOM DRIVE",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "396450511",
            "telephone_number": "601-657-4326",
            "fax_number": "601-657-8867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 WEST FREEDOM",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "396450511",
            "telephone_number": "601-657-4326",
            "fax_number": "601-657-8867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "FRANK",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "2544 90",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04781825",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, MS

Sources for this page

Verify at the official NPI Registry.