NPIMap

Organization Active NPI

Fredericksburg Dental Center, LLC

  • Dentist
  • Fredericksburg, PA
National Provider Identifier
1376645507
Registry record updated Jan 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
25124L Issued in PA
Legal business name
FREDERICKSBURG DENTAL CENTER, LLC
Practice address
120 South Tan Street
Fredericksburg, PA 17026
Phone
(717) 865-3457
Fax
(717) 865-2101
NPI assigned
Sep 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2014

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

Authorized official

Name
Dr. Andrew Thomas Stewart, DMDNPI 1154462539
Title
Owner
Phone
(717) 865-3457

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 25124L PA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 28749L PA

Addresses

Primary practice location

120 South Tan Street
Fredericksburg, PA 17026

Mailing address

PO Box 69
120 South Tan Street
Fredericksburg, PA 17026
Phone (717) 865-3457

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388620800000",
    "number": "1376645507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "address_2": "120 SOUTH TAN STREET",
            "city": "FREDERICKSBURG",
            "state": "PA",
            "postal_code": "17026",
            "telephone_number": "717-865-3457",
            "fax_number": "717-865-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SOUTH TAN STREET",
            "city": "FREDERICKSBURG",
            "state": "PA",
            "postal_code": "17026",
            "telephone_number": "717-865-3457",
            "fax_number": "717-865-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICKSBURG DENTAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2014-01-02",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-865-3457",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "25124L",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "28749L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.