MEDICARE: DR. ROBERT DON FREY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30 01 7929	OH

General Provider Information

NPI Number	:	1699777631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DON FREY DDS

Provider Business Mailing Address
First Line	:	104 MILLER AVE
Second Line	:
City	:	SWANTON
State	:	OH
Zip	:	43558-1245
Country	:	US
Telephone Number	:	419-826-2881
Fax Number	:	419-826-0333

Provider Business Practice Location Address
First Line	:	104 MILLER AVE
Second Line	:
City	:	SWANTON
State	:	OH
Zip	:	43558-1245
Country	:	US
Telephone Number	:	419-826-2881
Fax Number	:	419-826-0333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/09/2016

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