Provider Demographics
NPI:1962573766
Name:FREY, CONRAD FERDINAND III (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:FERDINAND
Last Name:FREY
Suffix:III
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:185 S BEADLE RD
Mailing Address - Street 2:BUILDING 1, SUITE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4287
Mailing Address - Country:US
Mailing Address - Phone:337-354-0004
Mailing Address - Fax:337-354-0005
Practice Address - Street 1:185 S BEADLE RD
Practice Address - Street 2:BUILDING 1, SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4287
Practice Address - Country:US
Practice Address - Phone:337-354-0004
Practice Address - Fax:337-354-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA47831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics