Provider Demographics
NPI:1356350284
Name:FRERE, JEFF LEE (DDS)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:LEE
Last Name:FRERE
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 1:2201 JAMES ST
Mailing Address - Street 2:STE A
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4154
Mailing Address - Country:US
Mailing Address - Phone:360-734-7055
Mailing Address - Fax:360-715-1151
Practice Address - Street 1:2201 JAMES ST
Practice Address - Street 2:STE A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4154
Practice Address - Country:US
Practice Address - Phone:360-734-7055
Practice Address - Fax:360-715-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000064691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice