| Columbia Prime Dental, Llc | |
|
6801 Douglas Legum Dr Ste C Elkridge MD 21075-6273 | |
| (410) 381-8283 | |
| (413) 254-5304 |
| Full Name | Columbia Prime Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6801 Douglas Legum Dr Ste C, Elkridge, Maryland |
| Authorized Official Name and Position | Ludmila Hristova Tchakarova (DDS/OWNER) |
| Authorized Official Contact | 4103818283 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Prime Dental, Llc 9084 Lambskin Ln Columbia MD 21045-2939 Ph: (410) 992-6793 | Columbia Prime Dental, Llc 6801 Douglas Legum Dr Ste C Elkridge MD 21075-6273 Ph: (410) 381-8283 |
| NPI Number | 1720370737 |
|---|---|
| Provider Enumeration Date | 05/09/2011 |
| Last Update Date | 07/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720370737 | NPI | - | NPPES |
| 027642100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 14156 (Maryland) | Primary |
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