Pediatric Dental Center of Frederick, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

14165 Issued in MD

Legal business name

PEDIATRIC DENTAL CENTER OF FREDERICK, LLC

Practice address

7360 Guilford Dr
102
Frederick, MD 21704-5124

Phone

(301) 668-2662

NPI assigned

Nov 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert W Mansman II, DDS

Title

Owner

Phone

(301) 668-2662

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1114094398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7360 GUILFORD DR",
            "address_2": "SUITE 102",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217045124",
            "telephone_number": "301-668-2662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7360 GUILFORD DR",
            "address_2": "102",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217045124",
            "telephone_number": "301-668-2662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL CENTER OF FREDERICK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "MANSMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-668-2662",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "14165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Frederick, MD
• Providers in Frederick, MD by specialty
• Pediatric Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.