Organization
LGM DDS LLC
Active
Other names
Pearl Smiles Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MEHRET GOITOM (OFFICE MANAGER)
(410) 799-1793
Entity
Organization
Contact information
Practice address
6020 MEADOW RDG CTR DR, SUITE A, ELKRIDGE, MD 21075-6088
(410) 799-1794
(410) 799-1794
Mailing address
6020 MEADOW RDG CTR DR, SUITE A, ELKRIDGE, MD 21075-6088
(410) 799-1794
(410) 799-1794
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14610
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04607880
—
DC
01
—
1912215856
INDIVIDUAL NPI NUMBER
MD
Enumeration date
08/08/2013
Last updated
11/06/2013
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