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NPI Code Detail

MEDICARE: LIFETIME DENTAL CARE OF MICHIGAN, P.C.

MEDICARE: LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1053952382
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Provider Business Mailing Address
First Line : 102 W HIGHLAND RD
Second Line :
City : HOWELL
State : MI
Zip : 48843-1159
Country : US
Telephone Number : 517-618-0954
Fax Number :
Provider Business Practice Location Address
First Line : 102 W HIGHLAND RD
Second Line :
City : HOWELL
State : MI
Zip : 48843-1159
Country : US
Telephone Number : 517-618-0954
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : JESSICA BRITT
Credential :
Telephone Number : 217-540-5100
Provider Enumeration Date : 10/08/2019
Last Update Date : 10/08/2019

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Directions to “LIFETIME DENTAL CARE OF MICHIGAN, P.C. ” Practice Location

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