Provider Demographics
NPI:1164634234
Name:PRINCE FREDERICK DENTAL CENTER
Entity Type:Organization
Organization Name:PRINCE FREDERICK DENTAL CENTER
Other - Org Name:N.O.W. DENTAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-5055
Mailing Address - Street 1:230 W DARES BEACH RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3150
Mailing Address - Country:US
Mailing Address - Phone:410-535-5055
Mailing Address - Fax:
Practice Address - Street 1:230 W DARES BEACH RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3150
Practice Address - Country:US
Practice Address - Phone:410-535-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126301223G0001X
MD115531223G0001X
MD118691223G0001X
MD85831223G0001X
MD126761223G0001X
MD125181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty