Provider Demographics
NPI:1780779660
Name:PHILIPPI, LARA E (DMD)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:E
Last Name:PHILIPPI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3078
Mailing Address - Country:US
Mailing Address - Phone:410-740-8588
Mailing Address - Fax:410-740-9755
Practice Address - Street 1:10910 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3078
Practice Address - Country:US
Practice Address - Phone:410-740-8588
Practice Address - Fax:410-740-9755
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice