Provider Demographics
NPI:1922896646
Name:SHORE FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:SHORE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGBO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-725-8373
Mailing Address - Street 1:11101 RESORT RD # 190
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2086
Mailing Address - Country:US
Mailing Address - Phone:410-725-8373
Mailing Address - Fax:
Practice Address - Street 1:8850 COLUMBIA 100 PKWY STE 310
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2377
Practice Address - Country:US
Practice Address - Phone:443-385-0285
Practice Address - Fax:443-385-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center