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General NPI Number Information
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NPI Number | 1568623056
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS OF FREDERICK
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 196 THOMAS JOHNSON DR SUITE 130
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City | FREDERICK
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State | MD
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Zip | 21702-4397
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Country | US
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Telephone | 301-663-5552
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Fax |
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Provider Business Mailing Address
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Address Line | 196 THOMAS JOHNSON DR SUITE 130
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City | FREDERICK
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State | MD
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Zip | 21702-4397
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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 | MANAGER
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Name | KEVIN S OAKES
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Credential |
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Telephone | 301-663-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 14295
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License Number State | MD
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