Provider Demographics
NPI:1942381892
Name:BLUMENFELD, FREDERICK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:BLUMENFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 BALTIMORE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1054
Mailing Address - Country:US
Mailing Address - Phone:301-864-5200
Mailing Address - Fax:301-864-5759
Practice Address - Street 1:6200 BALTIMORE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1054
Practice Address - Country:US
Practice Address - Phone:301-864-5200
Practice Address - Fax:301-864-5759
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD51321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice