Organization
PETRA DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARA E PHILIPPI D.M.D. (DENTIST/OWNER)
(410) 740-8588
Entity
Organization
Contact information
Practice address
10910 LITTLE PATUXENT PKWY, SUITE 206, COLUMBIA, MD 21044-3078
(410) 740-8588
(410) 740-9755
Mailing address
10910 LITTLE PATUXENT PKWY, SUITE 206, COLUMBIA, MD 21044-3078
(410) 740-8588
(410) 740-9755
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12458
MD
Other
Enumeration date
10/04/2006
Last updated
08/22/2020
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