NPIMap

Organization Active NPI

Opal Ridgedental LLC

  • General Practice Dentistry
  • Frederick, MD
National Provider Identifier
1326442286
Registry record updated Oct 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
15434 Issued in MD
Legal business name
OPAL RIDGEDENTAL LLC
Practice address
1700 Kingfisher Dr
Suite 11
Frederick, MD 21701-4775
Phone
(301) 788-8224
NPI assigned
Oct 21, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2014

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

Authorized official

Name
Dr. Renju Alex Thackenkary, DDSNPI 1932410297
Title
Owner
Phone
(301) 788-8224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 15434 MD Primary

Addresses

Primary practice location

1700 Kingfisher Dr
Suite 11
Frederick, MD 21701-4775

Mailing address

1700 Kingfisher Dr
Suite 11
Frederick, MD 21701
Phone (301) 788-8224

National Provider Directory

National Provider Directory

Locations

1700 Kingfisher Dr
Ste 11
Frederick, MD 21701
Phone (301) 501-5600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413849600000",
    "number": "1326442286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 KINGFISHER DR",
            "address_2": "SUITE 11",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21701",
            "telephone_number": "301-788-8224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 KINGFISHER DR",
            "address_2": "SUITE 11",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217014775",
            "telephone_number": "301-788-8224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPAL RIDGEDENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "THACKENKARY",
        "authorized_official_first_name": "RENJU",
        "authorized_official_middle_name": "ALEX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-788-8224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "15434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; 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.