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Organization
SHRIRAM DENTAL LLC
Active
Organization
SHRIRAM DENTAL LLC
Active
Other names
Legacy Dental Studio
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARUTA MODAK (OWNER DENTIST)
(410) 561-8845
Entity
Organization
Contact information
Practice address
9475 DEERECO RD STE 402, TIMONIUM, MD 21093-2124
(410) 561-8845
Mailing address
3141 SONIA TRL, ELLICOTT CITY, MD 21043-3276
(405) 208-9823
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/12/2025
Last updated
05/19/2025
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