Provider Demographics
NPI:1780988576
Name:FREY, BRENT JORDAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JORDAN
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 1:6525 BELCREST RD STE 290
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2062
Mailing Address - Country:US
Mailing Address - Phone:248-376-1059
Mailing Address - Fax:
Practice Address - Street 1:6525 BELCREST RD STE 290
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2062
Practice Address - Country:US
Practice Address - Phone:301-249-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412360122300000X
DCDEN10008721223X0400X
MD146961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist