Organization
LONGMEADOW FAMILY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON KEITH ELLIS DDS (PRES/OWNER)
(301) 739-1100
Entity
Organization
Contact information
Practice address
19638 LEITERSBURG PIKE, SUITE 103, HAGERSTOWN, MD 21742
(301) 739-1100
Mailing address
19638 LEITERSBURG PIKE, SUITE 103, HAGERSTOWN, MD 21742-1438
(301) 739-1100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
14739
MD
1223G0001X
General Practice Dentistry
Primary
12508
MD
Other
Enumeration date
08/18/2006
Last updated
11/08/2017
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