Healthcare Provider Details

I. General information

NPI: 1639099492
Provider Name (Legal Business Name): CONRAD FERDINAND FREY IV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S BEADLE RD STE C
LAFAYETTE LA
70508-4287
US

IV. Provider business mailing address

185 S BEADLE RD STE C
LAFAYETTE LA
70508-4287
US

V. Phone/Fax

Practice location:
  • Phone: 337-354-0004
  • Fax:
Mailing address:
  • Phone: 337-354-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7850
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: