Provider Demographics
NPI:1053401257
Name:FREY, BRADLEY S (DDS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:FREY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14333 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:301-953-1888
Mailing Address - Fax:301-953-1891
Practice Address - Street 1:14333 LAUREL BOWIE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:301-953-1888
Practice Address - Fax:301-953-1891
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121451223S0112X
DCDEN59351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01526 M02Medicare ID - Type Unspecified
U64134Medicare UPIN