NPIMap

Organization Active NPI

Lifetime Dental Care of Maryland, Badger, P.C.

Doing business as Severna Park Dental Care

  • General Practice Dentistry
  • Severna Park, MD
National Provider Identifier
1265971295
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
Doing business as
Severna Park Dental Care
Practice address
821 W Benfield Rd Ste 6
Severna Park, MD 21146-2220
Phone
(410) 987-3204
NPI assigned
Feb 23, 2017
Last updated
Aug 13, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF MARYLAND, GERALD AWADZI, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

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

Authorized official

Name
Brittany Nichelle Howard
Title
Credentialing Affiliation Coordinat
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

821 W Benfield Rd Ste 6
Severna Park, MD 21146-2220

Mailing address

1200 Network Centre Drive
Suite #2
Effingham, IL 62401
Phone (217) 540-8946

Other names 2

  • Severna Park Dental Care Doing business as
  • Dental Professionals of Maryland, Gerald Awadzi, P.C. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Maryland Gerald Awadzi PC16 organizations share this tax ID, including this one
Part of
Dental Professionals of Maryland Gerald Awadzi PC

Other organizations with this tax ID 15

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

View all 15

Locations

821 W Benfield Rd
Ste 6
Severna Park, MD 21146
Phone (410) 975-5447

NPI Registry JSON

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

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1265971295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NETWORK CENTRE DRIVE",
            "address_2": "SUITE #2",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "62401",
            "telephone_number": "217-540-8946",
            "fax_number": "217-540-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 W BENFIELD RD STE 6",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211462220",
            "telephone_number": "410-987-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF MARYLAND, GERALD AWADZI, P.C.",
        "enumeration_date": "2017-02-23",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_middle_name": "NICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING AFFILIATION COORDINAT",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Severna Park Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Severna Park Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental Professionals of Maryland, Gerald Awadzi, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Severna Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.