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General NPI Number Information
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NPI Number | 1255641171
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Entity Type | Organization
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Legal Business Name | LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 5850 WATERLOO RD STE 250
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City | COLUMBIA
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State | MD
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Zip | 21045-1943
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Country | US
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Telephone | 410-465-8480
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Fax | 410-465-7866
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Provider Business Mailing Address
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Address Line | 1200 NETWORK CENTRE DRIVE SUITE #2
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City | EFFINGHAM
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State | IL
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Zip | 62401
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Country | US
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Telephone | 217-540-8946
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Fax | 217-540-8946
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Authorized Official
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Title or Position | CREDENTIALING AFFILIATION COORDINAT
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Name | BRITTANY NICHELLE HOWARD
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Credential |
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Telephone | 217-540-8946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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