Provider Demographics
NPI:1932170685
Name:PAK, FRANCES (DMD)
Entity type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326A BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:STE A
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2128
Mailing Address - Country:US
Mailing Address - Phone:410-461-1166
Mailing Address - Fax:410-461-1470
Practice Address - Street 1:10326A BALTIMORE NATIONAL PIKE
Practice Address - Street 2:STE A
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2128
Practice Address - Country:US
Practice Address - Phone:410-461-1166
Practice Address - Fax:410-461-1470
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD365500800Medicaid