Healthcare Provider Details

I. General information

NPI: 1548638430
Provider Name (Legal Business Name): TOM FENLON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 FREDERICK RD SUITE 102
WEST FRIENDSHIP MD
21794-9564
US

IV. Provider business mailing address

PO BOX 340
WEST FRIENDSHIP MD
21794-0340
US

V. Phone/Fax

Practice location:
  • Phone: 410-442-2800
  • Fax:
Mailing address:
  • Phone: 410-442-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number5942
License Number StateMD

VIII. Authorized Official

Name: THOMAS J FENLON
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 410-442-2800