Organization
OPAL RIDGEDENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENJU ALEX THACKENKARY DDS (OWNER)
(301) 788-8224
Entity
Organization
Contact information
Practice address
1700 KINGFISHER DR, SUITE 11, FREDERICK, MD 21701-4775
(301) 788-8224
Mailing address
1700 KINGFISHER DR, SUITE 11, FREDERICK, MD 21701
(301) 788-8224
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15434
MD
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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