| Frederick Community Dental LLC | |
|
1100 W Patrick St Suite N Frederick MD 21703-3902 | |
| (443) 928-9708 | |
| Not Available |
| Full Name | Frederick Community Dental LLC |
|---|---|
| Speciality | Dentist |
| Location | 1100 W Patrick St, Frederick, Maryland |
| Authorized Official Name and Position | Dinesh Boppana (MEMBER) |
| Authorized Official Contact | 4439289708 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Frederick Community Dental LLC 6703 Jordan Valley Ct Frederick MD 21702-5812 | Frederick Community Dental LLC 1100 W Patrick St Suite N Frederick MD 21703-3902 Ph: (443) 928-9708 |
| NPI Number | 1992110167 |
|---|---|
| Provider Enumeration Date | 06/26/2014 |
| Last Update Date | 06/26/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992110167 | NPI | - | NPPES |
| 028083600 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 14609 (Maryland) | Primary |
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