Healthcare Provider Details

I. General information

NPI: 1568389906
Provider Name (Legal Business Name): PATERIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 OLD FARM DR STE F
FREDERICK MD
21702-5404
US

IV. Provider business mailing address

2090 OLD FARM DR STE F
FREDERICK MD
21702-5404
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-0181
  • Fax:
Mailing address:
  • Phone: 301-662-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ERIC COY
Title or Position: MEMBER
Credential: DDS, MS
Phone: 240-709-9249