MEDICARE: DR. LORRAINE LEE DRAGONIR D.D.S.

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	122300000X	Dentist	8278	MD

General Provider Information

NPI Number	:	1699936021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORRAINE LEE DRAGONIR D.D.S.

Provider Business Mailing Address
First Line	:	3529 SPLIT RAIL LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3832
Country	:	US
Telephone Number	:	410-245-2840
Fax Number	:	410-245-2840

Provider Business Practice Location Address
First Line	:	5565 STERRETT PL
Second Line	:	SUITE 121
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2665
Country	:	US
Telephone Number	:	410-245-2840
Fax Number	:	410-245-2840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	01/02/2016

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