Healthcare Provider Details

I. General information

NPI: 1194867085
Provider Name (Legal Business Name): FRANKLIN F FRUSH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 CROFTON CTR STE 7
CROFTON MD
21114
US

IV. Provider business mailing address

1667 CROFTON CTR STE 7
CROFTON MD
21114
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-2424
  • Fax: 410-451-0214
Mailing address:
  • Phone: 410-721-2424
  • Fax: 410-451-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4241
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: