Healthcare Provider Details

I. General information

NPI: 1902733090
Provider Name (Legal Business Name): LIFETIME FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 ATLANTIC AVE
BALDWIN NY
11510-4241
US

IV. Provider business mailing address

908 ATLANTIC AVE
BALDWIN NY
11510-4241
US

V. Phone/Fax

Practice location:
  • Phone: 516-546-9220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALLA KHOLDAROVA
Title or Position: OWNER
Credential:
Phone: 516-546-9229