PEDIATRIC DENTAL CENTER OF FREDERICK LLC NPI 1114094398

NPI Information

PEDIATRIC DENTAL CENTER OF FREDERICK, LLC is a pediatric dentistry dentist in Frederick, MD. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PEDIATRIC DENTAL CENTER OF FREDERICK, LLC NPI is 1114094398. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7360 GUILFORD DR
102
FREDERICK, MD
ZIP 21704-124
Phone: (301) 668-2662

The provider's authorized official is Robert W Mansman .
The authorized official title is Owner and has the following contact phone number (301) 668-2662.

The CLIA number assigned to this NPI record is 21D1107079 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/30/2006 and was last updated on 1/5/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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