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Organization
FREDERICK COMMUNITY DENTAL LLC
Active
Organization
FREDERICK COMMUNITY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DINESH BOPPANA (MEMBER)
(443) 928-9708
Entity
Organization
Contact information
Practice address
1100 W PATRICK ST, SUITE N, FREDERICK, MD 21703-3902
(443) 928-9708
Mailing address
6703 JORDAN VALLEY CT, FREDERICK, MD 21702-5812
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14609
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028083600
—
MD
Enumeration date
06/26/2014
Last updated
06/26/2014
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