Provider Demographics
NPI:1023388097
Name:ACADIA DENTAL OF FREDERICK
Entity Type:Organization
Organization Name:ACADIA DENTAL OF FREDERICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-797-2538
Mailing Address - Street 1:4640 HIGH POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:SWATARA
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2463
Mailing Address - Country:US
Mailing Address - Phone:717-564-8700
Mailing Address - Fax:
Practice Address - Street 1:18077 GARLAND GROH BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-2064
Practice Address - Country:US
Practice Address - Phone:301-797-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty