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General NPI Number Information
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NPI Number | 1922896646
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Entity Type | Organization
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Legal Business Name | SHORE FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 8850 COLUMBIA 100 PKWY STE 310
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City | COLUMBIA
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State | MD
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Zip | 21045-2377
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Country | US
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Telephone | 443-385-0285
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Fax | 443-385-0286
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Provider Business Mailing Address
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Address Line | 11101 RESORT RD # 190
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2086
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Country | US
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Telephone | 410-725-8373
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | IJEOMA TAGBO
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Credential | DMD
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Telephone | 410-725-8373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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