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General NPI Number Information
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NPI Number | 1598957342
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Entity Type | Individual
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Provider Name | FREDERICK JOHN RUMFORD IV D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 2005 KNIGHT LANE BLDG H NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 760-725-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 317 PINE AVE 103
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City | CARLSBAD
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State | CA
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Zip | 92008-3180
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Country | US
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Telephone | 617-645-4515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS037322
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License Number State | PA
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