Provider Demographics
NPI:1043362478
Name:DENTAL SERVICES OF FREDERICK,LLC
Entity Type:Organization
Organization Name:DENTAL SERVICES OF FREDERICK,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE ADMINISTRATOR
Authorized Official - Phone:301-620-1117
Mailing Address - Street 1:198 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 18
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4398
Mailing Address - Country:US
Mailing Address - Phone:301-620-1117
Mailing Address - Fax:301-620-9768
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 18
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:301-620-1117
Practice Address - Fax:301-620-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD41521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty