NPIMap

Organization Active NPI

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

  • General Practice Dentistry
  • Leonardtown, MD
National Provider Identifier
1669893475
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.
Practice address
23140 Moakley St
Suite 5
Leonardtown, MD 20650-2930
Phone
(301) 475-2881
NPI assigned
Dec 20, 2013
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 DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

23140 Moakley St
Suite 5
Leonardtown, MD 20650-2930

Mailing address

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

Other names 2

  • Breton Bay Dentistry Doing business as
  • Dental Professionals of Maryland, Gerald Awadzi, PC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Pennsylvania PC40 organizations share this tax ID, including this one
Part of
Lifetime Dental Care of Maryland Badger PC

Other organizations with this tax ID 39

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

View all 39

Locations

23140 Moakley St
Ste 5
Leonardtown, MD 20650
Phone (301) 475-2881

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1387497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1669893475",
    "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": "23140 MOAKLEY ST",
            "address_2": "SUITE 5",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206502930",
            "telephone_number": "301-475-2881"
        }
    ],
    "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": "2013-12-20",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Breton Bay Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental Professionals of Maryland, Gerald Awadzi, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Leonardtown, 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.