Organization
FREDERICK KIDDS PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
D'AUDRA COLE DDS (DENTIST/OWNER)
(301) 202-5041
Entity
Organization
Contact information
Practice address
211 SHOREBIRD ST STE B, FREDERICK, MD 21701-1963
(301) 202-5041
Mailing address
211 SHOREBIRD ST STE B, FREDERICK, MD 21701-1963
(301) 202-5041
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14079
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194880633
INDIVIDUAL NPI
MD
Enumeration date
07/14/2015
Last updated
07/14/2015
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