Provider Demographics
NPI:1568061166
Name:FREDERICK CENTER FOR DENTISTRY, LLC
Entity Type:Organization
Organization Name:FREDERICK CENTER FOR DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-858-7580
Mailing Address - Street 1:13609 GILBRIDE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1019
Mailing Address - Country:US
Mailing Address - Phone:410-858-7580
Mailing Address - Fax:
Practice Address - Street 1:140 THOMAS JOHNSON DR STE 203
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4485
Practice Address - Country:US
Practice Address - Phone:301-662-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty