Healthcare Provider Details

I. General information

NPI: 1205055068
Provider Name (Legal Business Name): NEWELL RICHARD FREI DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD FREI DDS MS

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 E HARMON #3
LAS VEGAS NV
89121
US

IV. Provider business mailing address

2430 E HARMON #3
LAS VEGAS NV
89121
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-4169
  • Fax: 702-735-8697
Mailing address:
  • Phone: 702-735-4169
  • Fax: 702-735-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0661
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: