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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