Provider Demographics
NPI:1437261609
Name:FREY, LOREEN KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOREEN
Middle Name:KAY
Last Name:FREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LOREEN
Other - Middle Name:KAY
Other - Last Name:DEMOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1142 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891
Mailing Address - Country:US
Mailing Address - Phone:419-238-9368
Mailing Address - Fax:419-238-9193
Practice Address - Street 1:1142 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891
Practice Address - Country:US
Practice Address - Phone:419-238-9368
Practice Address - Fax:419-238-9193
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0824559Medicaid