Provider Demographics
NPI:1922011337
Name:FREY, JAMES TERRY (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TERRY
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:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-5008
Mailing Address - Country:US
Mailing Address - Phone:812-346-6884
Mailing Address - Fax:812-346-1717
Practice Address - Street 1:623 N STATE STREET
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265
Practice Address - Country:US
Practice Address - Phone:812-346-6884
Practice Address - Fax:812-346-6884
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120069391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice