NPIMap

Organization Active NPI

LGM DDS LLC

Doing business as Pearl Smiles Dental

  • General Practice Dentistry
  • Elkridge, MD
National Provider Identifier
1861824104
Registry record updated Nov 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14610 Issued in MD
Legal business name
LGM DDS LLC
Doing business as
Pearl Smiles Dental
Practice address
6020 Meadow RDG Ctr Dr
Suite a
Elkridge, MD 21075-6088
Phone
(410) 799-1794
Fax
(410) 799-1794
NPI assigned
Aug 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2013

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

Authorized official

Name
Mehret Goitom
Title
Office Manager
Phone
(410) 799-1793

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 14610 MD Primary

Addresses

Primary practice location

6020 Meadow RDG Ctr Dr
Suite a
Elkridge, MD 21075-6088

Mailing address

6020 Meadow RDG Ctr Dr
Suite a
Elkridge, MD 21075-6088
Phone (410) 799-1794

Other identifiers 2

IdentifierTypeStateIssuer
1912215856OtherMDINDIVIDUAL NPI NUMBER
04607880MedicaidDC

Other names 1

  • Pearl Smiles Dental Doing business as

National Provider Directory

National Provider Directory

Locations

6020 Meadowridge Center Dr
Ste A
Elkridge, MD 21075
Phone (410) 799-1793

Practitioners & affiliated clinicians

Practitioners 1

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": "1375920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383696000000",
    "number": "1861824104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6020 MEADOW RDG CTR DR",
            "address_2": "SUITE A",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210756088",
            "telephone_number": "410-799-1794",
            "fax_number": "410-799-1794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6020 MEADOW RDG CTR DR",
            "address_2": "SUITE A",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210756088",
            "telephone_number": "410-799-1794",
            "fax_number": "410-799-1794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LGM DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-08",
        "last_updated": "2013-11-06",
        "status": "A",
        "authorized_official_last_name": "GOITOM",
        "authorized_official_first_name": "MEHRET",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "410-799-1793"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "14610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1912215856",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04607880",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearl Smiles Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkridge, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; 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.