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General NPI Number Information
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NPI Number | 1720168917
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Entity Type | Individual
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Provider Name | TARA M FREY DDS
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 GRAYSON RD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3745
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Country | US
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Telephone | 757-473-8482
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Fax | 757-743-8486
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Provider Business Mailing Address
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Address Line | 200 GRAYSON ROAD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462
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Country | US
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Telephone | 757-473-8482
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Fax | 757-473-8486
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401410069
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License Number State | VA
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