Provider Demographics
NPI:1588918767
Name:FREY, STEVEN M (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
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 1:6323 CORPORATE CT STE A
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3518
Mailing Address - Country:US
Mailing Address - Phone:239-482-5311
Mailing Address - Fax:
Practice Address - Street 1:6323 CORPORATE CT STE A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3518
Practice Address - Country:US
Practice Address - Phone:239-482-5311
Practice Address - Fax:239-482-8531
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010211391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics