=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851797732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREDERICK DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2014
-----------------------------------------------------
Last Update Date | 11/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 W 7TH STREET FREDERICK DENTAL
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-7766
-----------------------------------------------------
Fax | 301-662-7776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 W 7TH STREET
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-7766
-----------------------------------------------------
Fax | 301-662-7776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ADAM J FRIEDER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 301-662-7766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4508
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------