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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