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General NPI Number Information
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NPI Number | 1861824104
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Entity Type | Organization
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Legal Business Name | LGM DDS LLC
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 6020 MEADOW RDG CTR DR SUITE A
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City | ELKRIDGE
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State | MD
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Zip | 21075-6088
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Country | US
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Telephone | 410-799-1794
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Fax | 410-799-1794
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Provider Business Mailing Address
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Address Line | 6020 MEADOW RDG CTR DR SUITE A
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City | ELKRIDGE
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State | MD
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Zip | 21075-6088
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Country | US
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Telephone | 410-799-1794
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Fax | 410-799-1794
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MEHRET GOITOM
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Credential |
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Telephone | 410-799-1793
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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 | 14610
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License Number State | MD
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