Provider Demographics
NPI:1366531931
Name:FREYER, PETER SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SCOTT
Last Name:FREYER
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 1:1111 LANGLADE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2738
Mailing Address - Country:US
Mailing Address - Phone:715-627-4383
Mailing Address - Fax:
Practice Address - Street 1:112 EAST FIFTH AVE
Practice Address - Street 2:LANGLADE MEMORIAL HOSPITAL
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2710
Practice Address - Country:US
Practice Address - Phone:715-539-8181
Practice Address - Fax:715-539-2462
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38392400Medicaid
WI33787200Medicaid