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General NPI Number Information
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NPI Number | 1720370737
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Entity Type | Organization
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Legal Business Name | COLUMBIA PRIME DENTAL, LLC
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Dates
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Enumeration Date | 05/09/2011
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 6801 DOUGLAS LEGUM DR STE C
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City | ELKRIDGE
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State | MD
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Zip | 21075-6273
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Country | US
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Telephone | 410-381-8283
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Fax | 413-254-5304
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Provider Business Mailing Address
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Address Line | 9084 LAMBSKIN LN
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City | COLUMBIA
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State | MD
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Zip | 21045-2939
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Country | US
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Telephone | 410-992-6793
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Fax |
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Authorized Official
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Title or Position | DDS/OWNER
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Name | LUDMILA HRISTOVA TCHAKAROVA
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Credential | DDS
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Telephone | 410-381-8283
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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 | 14156
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License Number State | MD
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