Frederick Community Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

14609 Issued in MD

Legal business name

FREDERICK COMMUNITY DENTAL LLC

Practice address

1100 W Patrick St
Suite N
Frederick, MD 21703-3902

Phone

(443) 928-9708

NPI assigned

Jun 26, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Dinesh Boppana

Title

Member

Phone

(443) 928-9708

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1992110167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6703 JORDAN VALLEY CT",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217025812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W PATRICK ST",
            "address_2": "SUITE N",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217033902",
            "telephone_number": "443-928-9708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK COMMUNITY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "BOPPANA",
        "authorized_official_first_name": "DINESH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "443-928-9708",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "14609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028083600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Frederick, MD
• Providers in Frederick, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.