Provider Demographics
NPI:1992899488
Name:LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
Entity type:Organization
Organization Name:LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-6078
Mailing Address - Street 1:535 MAIN ST STE 113
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4335
Mailing Address - Country:US
Mailing Address - Phone:301-490-0044
Mailing Address - Fax:
Practice Address - Street 1:535 MAIN STREET
Practice Address - Street 2:SUITE 113
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4335
Practice Address - Country:US
Practice Address - Phone:301-490-0044
Practice Address - Fax:301-497-1900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETIME DENTAL CARE OF MARYLAND, BADGER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty