Provider Demographics
NPI:1942659057
Name:FREDERICK PERIODONTAL ASSOCIATES
Entity Type:Organization
Organization Name:FREDERICK PERIODONTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:301-620-1692
Mailing Address - Street 1:130 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4419
Mailing Address - Country:US
Mailing Address - Phone:301-620-1692
Mailing Address - Fax:301-620-1444
Practice Address - Street 1:130 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 6
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4419
Practice Address - Country:US
Practice Address - Phone:301-620-1692
Practice Address - Fax:301-620-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty