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General NPI Number Information
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NPI Number | 1669779518
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Entity Type | Organization
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Legal Business Name | FDC-DDS PC
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 4644 RIDGE RD
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City | MOUNT AIRY
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State | MD
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Zip | 21771-8901
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Country | US
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Telephone | 410-875-2323
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Fax | 410-875-2323
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Provider Business Mailing Address
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Address Line | 4644 RIDGE RD
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City | MOUNT AIRY
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State | MD
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Zip | 21771-8901
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Country | US
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Telephone | 410-875-2323
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SONIA ELISABETH CLESNER
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Credential | DDS
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Telephone | 410-875-2323
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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 | 8011
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License Number State | MD
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