Provider Demographics
NPI:1497809602
Name:FREY, VINCENT MARTIN (DMD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:MARTIN
Last Name:FREY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444
Mailing Address - Country:US
Mailing Address - Phone:973-831-0382
Mailing Address - Fax:913-831-6942
Practice Address - Street 1:28 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444
Practice Address - Country:US
Practice Address - Phone:973-831-0382
Practice Address - Fax:913-831-6942
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1013285001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3165108Medicaid
NJ1211307Medicaid
NJ161361Medicare ID - Type Unspecified
NJ1211307Medicaid