Provider Demographics
NPI:1821220294
Name:DOW CLARK DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:DOW CLARK DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:DOUGLASS
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-686-1070
Mailing Address - Street 1:6188 OXON HILL RD
Mailing Address - Street 2:SUITE 604
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3113
Mailing Address - Country:US
Mailing Address - Phone:301-686-1070
Mailing Address - Fax:301-686-1072
Practice Address - Street 1:6188 OXON HILL RD
Practice Address - Street 2:SUITE 604
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3113
Practice Address - Country:US
Practice Address - Phone:301-686-1070
Practice Address - Fax:301-686-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05724244Medicaid