Provider Demographics
NPI:1043226244
Name:FREY, M. SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:M. SCOTT
Middle Name:
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 1:506 CORDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-4935
Mailing Address - Country:US
Mailing Address - Phone:765-362-3333
Mailing Address - Fax:765-362-8641
Practice Address - Street 1:506 CORDA BLVD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-4935
Practice Address - Country:US
Practice Address - Phone:765-362-3333
Practice Address - Fax:765-362-8641
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120099611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice