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Organization
FREDERICK W. BROADHEAD, DMD, PC
Active
Organization
FREDERICK W. BROADHEAD, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK WRIGHT BROADHEAD DMD (OWNER)
(540) 635-4567
Entity
Organization
Contact information
Practice address
80 W 4TH ST, FRONT ROYAL, VA 22630-2608
(540) 635-4567
(540) 635-6794
Mailing address
80 W 4TH ST, FRONT ROYAL, VA 22630-2608
(540) 635-4567
(540) 635-6794
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401411086
VA
261QD0000X
Dental Clinic/Center
0401413785
VA
Other
Enumeration date
01/03/2013
Last updated
01/03/2013
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