Individual provider Active NPI

Matthew David Freytag, D.D.S.

  • General Practice Dentistry
  • Walbridge, OH
National Provider Identifier
1871713396
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
21563 Issued in OH
Practice address
403 N Main St
Walbridge, OH 43465-1018
Phone
(419) 666-1776
Fax
(419) 666-7578
NPI assigned
Apr 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 21563 OH Primary

Addresses

Primary practice location

403 N Main St
Walbridge, OH 43465-1018

Mailing address

403 N Main St
Box 548
Walbridge, OH 43465-1018
Phone (419) 666-1776

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20151215002928 OH Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5991006942

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21563OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Freytag Dental General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871713396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 N MAIN ST",
            "address_2": "BOX 548",
            "city": "WALBRIDGE",
            "state": "OH",
            "postal_code": "434651018",
            "telephone_number": "419-666-1776",
            "fax_number": "419-666-7578"
        },
        {
            "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",
            "fax_number": "419-666-7578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREYTAG",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "21563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walbridge, OH

Sources for this page

Verify at the official NPI Registry.