| Longmeadow Family Dental Care | |
|
19638 Leitersburg Pike Suite 103 Hagerstown MD 21742 | |
| (301) 739-1100 | |
| Not Available |
| Full Name | Longmeadow Family Dental Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 19638 Leitersburg Pike, Hagerstown, Maryland |
| Authorized Official Name and Position | Brandon Keith Ellis (PRES/OWNER) |
| Authorized Official Contact | 3017391100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Longmeadow Family Dental Care 19638 Leitersburg Pike Suite 103 Hagerstown MD 21742-1438 Ph: (301) 739-1100 | Longmeadow Family Dental Care 19638 Leitersburg Pike Suite 103 Hagerstown MD 21742 Ph: (301) 739-1100 |
| NPI Number | 1174637185 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 11/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174637185 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 14739 (Maryland) | Secondary |
| 1223G0001X | Dentist - General Practice | 12508 (Maryland) | Primary |
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