Provider Demographics
NPI:1003815002
Name:FREY, JOHN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
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 1:6220 JUPITER AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8709
Mailing Address - Country:US
Mailing Address - Phone:616-222-0202
Mailing Address - Fax:616-222-0203
Practice Address - Street 1:6220 JUPITER AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8708
Practice Address - Country:US
Practice Address - Phone:616-222-0202
Practice Address - Fax:616-222-0203
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010170471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice