NPIMap

Organization Active NPI

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

Doing business as Fairway Village Dental Care

  • Dentist
  • Waldorf, MD
National Provider Identifier
1285504662
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
Doing business as
Fairway Village Dental Care
Practice address
4576 Fairway Village PL Ste 101
Waldorf, MD 20602-5108
Phone
(227) 220-4015
NPI assigned
Nov 10, 2025
Last updated
Nov 10, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

4576 Fairway Village PL Ste 101
Waldorf, MD 20602-5108

Mailing address

4576 Fairway Village PL Ste 101
Waldorf, MD 20602-5108

Other names 1

  • Fairway Village Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Dental Care of Maryland Badger PC12 organizations share this tax ID, including this one
Part of
Lifetime Dental Care of Maryland Badger PC

Other organizations with this tax ID 11

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

Locations

4576 Fairway Village Pl
Ste 101
Waldorf, MD 20602
Phone (227) 220-4015

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1762732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1285504662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4576 FAIRWAY VILLAGE PL STE 101",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206025108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4576 FAIRWAY VILLAGE PL STE 101",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206025108",
            "telephone_number": "227-220-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.",
        "enumeration_date": "2025-11-10",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairway Village Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; 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.