| Opal Ridgedental LLC | |
|
1700 Kingfisher Dr Suite 11 Frederick MD 21701-4775 | |
| (301) 788-8224 | |
| Not Available |
| Full Name | Opal Ridgedental LLC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1700 Kingfisher Dr, Frederick, Maryland |
| Authorized Official Name and Position | Renju Alex Thackenkary (OWNER) |
| Authorized Official Contact | 3017888224 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Opal Ridgedental LLC 1700 Kingfisher Dr Suite 11 Frederick MD 21701 Ph: (301) 788-8224 | Opal Ridgedental LLC 1700 Kingfisher Dr Suite 11 Frederick MD 21701-4775 Ph: (301) 788-8224 |
| NPI Number | 1326442286 |
|---|---|
| Provider Enumeration Date | 10/21/2014 |
| Last Update Date | 10/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326442286 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 15434 (Maryland) | Primary |
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