Provider Demographics
NPI:1891150744
Name:DENTAL ASSOCIATES OF FREDERICK, LLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF FREDERICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:OAKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-668-7700
Mailing Address - Street 1:196 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 235
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4397
Mailing Address - Country:US
Mailing Address - Phone:301-668-7700
Mailing Address - Fax:
Practice Address - Street 1:196 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 235
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4397
Practice Address - Country:US
Practice Address - Phone:301-668-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty