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General NPI Number Information
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NPI Number | 1114094398
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CENTER OF FREDERICK, LLC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 7360 GUILFORD DR 102
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City | FREDERICK
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State | MD
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Zip | 21704-5124
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Country | US
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Telephone | 301-668-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 7360 GUILFORD DR SUITE 102
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City | FREDERICK
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State | MD
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Zip | 21704-5124
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Country | US
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Telephone | 301-668-2662
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT W MANSMAN II
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Credential | DDS
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Telephone | 301-668-2662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 14165
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License Number State | MD
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