MEDICARE: FREDERICK CENTER FOR DENTISTRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1568061166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERICK CENTER FOR DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	13609 GILBRIDE LN
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1019
Country	:	US
Telephone Number	:	410-858-7580
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 THOMAS JOHNSON DR STE 203
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4485
Country	:	US
Telephone Number	:	301-662-8675
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. SAHIL GOYAL
Credential	:	DMD
Telephone Number	:	410-858-7580

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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