NPIMap

Organization Active NPI

Logos Dental

  • General Practice Dentistry
  • Elkton, MD
National Provider Identifier
1265734743
Registry record updated Dec 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10839 Issued in MD
Legal business name
LOGOS DENTAL
Practice address
130 E Pulaski Hwy
Elkton, MD 21921-6430
Phone
(443) 350-9221
NPI assigned
Dec 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Kim, DDS
Title
President
Phone
(443) 350-9221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10839 MD Primary

Addresses

Primary practice location

130 E Pulaski Hwy
Elkton, MD 21921-6430

Mailing address

130 E Pulaski Hwy
Elkton, MD 21921-6430
Phone (443) 350-9221

Other identifiers 1

IdentifierTypeStateIssuer
081934400MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Logos Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

130 E Pulaski Hwy
Elkton, MD 21921
Phone (410) 620-2220

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291334400000",
    "number": "1265734743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E PULASKI HWY",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219216430",
            "telephone_number": "443-350-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E PULASKI HWY",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219216430",
            "telephone_number": "443-350-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGOS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-03",
        "last_updated": "2010-12-03",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-350-9221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "10839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081934400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.