NPIMap

Organization Active NPI

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

  • General Practice Dentistry
  • Laurel, MD
National Provider Identifier
1992899488
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10680 Issued in MD
Legal business name
LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
Practice address
535 Main Street
Suite 113
Laurel, MD 20707-4335
Phone
(301) 490-0044
Fax
(301) 497-1900
NPI assigned
Oct 2, 2006
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 Jun 7, 2021

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10680 MD Primary

Addresses

Primary practice location

535 Main Street
Suite 113
Laurel, MD 20707-4335

Mailing address

535 Main St Ste 113
Laurel, MD 20707-4335
Phone (301) 490-0044

Other names 2

  • Olde Town Laurel Dental Doing business as
  • Dental Professionals of Maryland, Gerald Awadzi, P.C. Former legal business name

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

535 Main St
Ste 113
Laurel, MD 20707
Phone (301) 490-0044

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 4

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623024000000",
    "number": "1992899488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 MAIN ST STE 113",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074335",
            "telephone_number": "301-490-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 MAIN STREET",
            "address_2": "SUITE 113",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074335",
            "telephone_number": "301-490-0044",
            "fax_number": "301-497-1900"
        }
    ],
    "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": "2006-10-02",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "10680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olde Town Laurel Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental Professionals of Maryland, Gerald Awadzi, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; 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.