Shriram Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SHRIRAM DENTAL LLC

Doing business as

Legacy Dental Studio

Practice address

9475 Deereco Rd Ste 402
Timonium, MD 21093-2124

Phone

(410) 561-8845

NPI assigned

May 12, 2025

Last updated

May 19, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Charuta ModakNPI 1699276279

Title

Owner Dentist

Phone

(410) 561-8845

Specialties & licenses 1

Addresses

Other names 1

• Legacy Dental Studio Doing business as

Practitioners 3

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.

• Charuta Modak, DMD

  • General Practice Dentistry
  • Baltimore, MD
  • NPI 1699276279
  NPD Authorized official
• Angela Marie Whelan, RDH

  • Other Technician
  • Timonium, MD
  • NPI 1538914957
  NPD
• Lynn Renee Chincheck, D.D.S.

  • General Practice Dentistry
  • Timonium, MD
  • NPI 1780720615
  NPD (past)

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

{
    "created_epoch": "1747008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1780474627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3141 SONIA TRL",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210433276",
            "telephone_number": "405-208-9823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9475 DEERECO RD STE 402",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932124",
            "telephone_number": "410-561-8845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHRIRAM DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-12",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "MODAK",
        "authorized_official_first_name": "CHARUTA",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "410-561-8845",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Dental Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mark Shulman, DDS
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• Dentist in Timonium, MD
• Providers in Timonium, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.