Provider Demographics
NPI:1043570807
Name:FREY FAMILY DENTISTRY PSC
Entity type:Organization
Organization Name:FREY FAMILY DENTISTRY PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-423-5177
Mailing Address - Street 1:2809 N HURSTBOURNE PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1283
Mailing Address - Country:US
Mailing Address - Phone:502-423-5177
Mailing Address - Fax:502-423-5179
Practice Address - Street 1:2809 N HURSTBOURNE PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1283
Practice Address - Country:US
Practice Address - Phone:502-423-5177
Practice Address - Fax:502-423-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY91701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty