NPIMap

Organization Active NPI

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

  • Dentist
  • Crofton, MD
National Provider Identifier
1619032620
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
Practice address
2191 Defense Hwy #210
Crofton, MD 21114
Phone
(410) 721-2610
Fax
(410) 721-8053
NPI assigned
Dec 27, 2006
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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2191 Defense Hwy #210
Crofton, MD 21114

Mailing address

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

Other names 1

  • Dental Professionals of Maryland, Gerald Awadzi, PC Former legal business name

National Provider Directory

National Provider Directory
Part of
Dental Professionals of Maryland Gerald Awadzi PC

Locations

2191 Defense Hwy
Ste 210
Crofton, MD 21114
Phone (410) 721-2610

Practitioners & affiliated clinicians

Practitioners 10

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": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1619032620",
    "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": "2191 DEFENSE HWY #210",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "21114",
            "telephone_number": "410-721-2610",
            "fax_number": "410-721-8053"
        }
    ],
    "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": "2006-12-27",
        "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": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Professionals of Maryland, Gerald Awadzi, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Crofton, 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.