MEDICARE: DENTAL PROFESSIONALS OF MARYLAND, BADGER, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1154631075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PROFESSIONALS OF MARYLAND, BADGER, P.C.

Provider Business Mailing Address
First Line	:	7500 MONTPELIER RD STE 108
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-6012
Country	:	US
Telephone Number	:	301-617-0880
Fax Number	:	301-617-0817

Provider Business Practice Location Address
First Line	:	7500 MONTPELIER RD STE 108
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-6012
Country	:	US
Telephone Number	:	301-617-0880
Fax Number	:	301-617-0817

Authorized Official
Title or Position	:	INSURANCE/CREDENTIALING
Name	:	CARMEN WOODS
Credential	:
Telephone Number	:	217-540-5100

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	11/06/2021

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