| NPI | 1962190025 |
|---|---|
| Doing Business As | FREDERICK DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | CHETAN BADDAM Owner 217-414-4234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2023-04-26 |