Provider Demographics
NPI:1669779518
Name:FDC-DDS PC
Entity type:Organization
Organization Name:FDC-DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:CLESNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-875-2323
Mailing Address - Street 1:4644 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-8901
Mailing Address - Country:US
Mailing Address - Phone:410-875-2323
Mailing Address - Fax:
Practice Address - Street 1:4644 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-8901
Practice Address - Country:US
Practice Address - Phone:410-875-2323
Practice Address - Fax:410-875-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty