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General NPI Number Information
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NPI Number | 1568587772
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Entity Type | Organization
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Legal Business Name | DENTAL ONE ASSOCIATES FREDERICK PC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 45 THOMAS JOHNSON DR SUITE 105
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City | FREDERICK
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State | MD
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Zip | 21702-4301
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Country | US
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Telephone | 301-696-8664
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Fax |
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Provider Business Mailing Address
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Address Line | 45 THOMAS JOHNSON DR SUITE 105
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City | FREDERICK
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State | MD
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Zip | 21702-4301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE DIRECTOR
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Name | MIKE COLE
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Credential |
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Telephone | 727-726-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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