Provider Demographics
NPI:1356726301
Name:LUXE DENTAL CARE LLC
Entity type:Organization
Organization Name:LUXE DENTAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SADAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-949-2298
Mailing Address - Street 1:352 THOMPSON CREEK MALL
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2500
Mailing Address - Country:US
Mailing Address - Phone:410-934-0123
Mailing Address - Fax:410-934-0124
Practice Address - Street 1:352 THOMPSON CREEK MALL
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2500
Practice Address - Country:US
Practice Address - Phone:410-934-0123
Practice Address - Fax:410-934-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126831223G0001X
1223G0001X
MD143741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD071636700Medicaid
MD415749400Medicaid
MD086220700Medicaid
MD058463100Medicaid