Provider Demographics
NPI:1174600464
Name:MARK A. FREEMAN JEFFREY A. SHORT PLLC
Entity type:Organization
Organization Name:MARK A. FREEMAN JEFFREY A. SHORT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:206-621-9730
Mailing Address - Street 1:509 OLIVE WAY STE 1511
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1749
Mailing Address - Country:US
Mailing Address - Phone:206-621-9730
Mailing Address - Fax:206-621-7053
Practice Address - Street 1:509 OLIVE WAY STE 1511
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1749
Practice Address - Country:US
Practice Address - Phone:206-621-9730
Practice Address - Fax:206-621-7053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty