Provider Demographics
NPI:1942212048
Name:ANTIETAM PERIODONTICS PA DRS. FRED & REBECCA BYE
Entity Type:Organization
Organization Name:ANTIETAM PERIODONTICS PA DRS. FRED & REBECCA BYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:301-739-6868
Mailing Address - Street 1:13424 PENNSYLVANIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2686
Mailing Address - Country:US
Mailing Address - Phone:301-739-6868
Mailing Address - Fax:301-790-4990
Practice Address - Street 1:13424 PENNSYLVANIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2686
Practice Address - Country:US
Practice Address - Phone:301-739-6868
Practice Address - Fax:301-790-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty