Provider Demographics
NPI:1053336305
Name:FREY, BRADLEY M (DMD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:FREY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 STERN RD
Mailing Address - Street 2:
Mailing Address - City:SEAMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45679-9607
Mailing Address - Country:US
Mailing Address - Phone:937-386-1379
Mailing Address - Fax:937-386-0129
Practice Address - Street 1:218 STERN RD
Practice Address - Street 2:
Practice Address - City:SEAMAN
Practice Address - State:OH
Practice Address - Zip Code:45679-9607
Practice Address - Country:US
Practice Address - Phone:937-386-1379
Practice Address - Fax:937-386-0129
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-0786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist