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NPI Code Detail

MEDICARE: LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.

MEDICARE: LIFETIME DENTAL CARE 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
11223G0001XGeneral Practice Dentistry

General Provider Information

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

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Directions to “LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C. ” Practice Location

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