Provider Demographics
NPI:1669112322
Name:FREY, KAITLYN (DMD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CANYON DR APT 6
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1071
Mailing Address - Country:US
Mailing Address - Phone:570-807-6505
Mailing Address - Fax:
Practice Address - Street 1:400 WARREN AVE STE 200
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1467
Practice Address - Country:US
Practice Address - Phone:360-478-2366
Practice Address - Fax:360-373-2096
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61265346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist