Provider Demographics
NPI:1063772952
Name:FREY, DONALD T (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:T
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 1:2809 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
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY91701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice