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NPI Code Detail

MEDICARE: LANDMARK DENTAL LLC

MEDICARE: LANDMARK DENTAL LLC
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
1261QD0000XDental Clinic/Center16613MD

General Provider Information

NPI Number : 1346746989
Entity Type Code : Organization
Provider Name (Legal Business Name) : LANDMARK DENTAL LLC
Provider Business Mailing Address
First Line : 122 N PHILADELPHIA BLVD
Second Line :
City : ABERDEEN
State : MD
Zip : 21001-2513
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 122 N PHILADELPHIA BLVD
Second Line :
City : ABERDEEN
State : MD
Zip : 21001-2513
Country : US
Telephone Number : 443-345-1246
Fax Number : 443-345-1248
Authorized Official
Title or Position : OWNER
Name : ALI KHAYYER
Credential : DDS
Telephone Number : 703-300-6503
Provider Enumeration Date : 04/03/2018
Last Update Date : 04/03/2018

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Directions to “LANDMARK DENTAL LLC ” Practice Location

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