Provider Demographics
NPI:1669007993
Name:FREDERICK ORTHODONTICS ASSOCIATES LLC
Entity Type:Organization
Organization Name:FREDERICK ORTHODONTICS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR/BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-631-0501
Mailing Address - Street 1:52 THOMAS JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4501
Mailing Address - Country:US
Mailing Address - Phone:301-631-0501
Mailing Address - Fax:301-631-0601
Practice Address - Street 1:52 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4501
Practice Address - Country:US
Practice Address - Phone:301-631-0501
Practice Address - Fax:301-631-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty