Provider Demographics
NPI:1972610558
Name:LICHTMAN, THEDORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEDORE
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 SUPERIOR LN
Mailing Address - Street 2:STE 101
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715
Mailing Address - Country:US
Mailing Address - Phone:301-464-2323
Mailing Address - Fax:301-464-2125
Practice Address - Street 1:3327 SUPERIOR LN
Practice Address - Street 2:STE 101
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1922
Practice Address - Country:US
Practice Address - Phone:301-464-2323
Practice Address - Fax:301-464-2125
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist