Provider Demographics
NPI:1073762837
Name:FREI, KYLE D (DDS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:D
Last Name:FREI
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 1:111 E 100 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3428
Mailing Address - Country:US
Mailing Address - Phone:435-673-6831
Mailing Address - Fax:
Practice Address - Street 1:111 E 100 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3428
Practice Address - Country:US
Practice Address - Phone:435-673-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist