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General NPI Number Information
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NPI Number | 1477261329
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Entity Type | Organization
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Legal Business Name | LIFETIME DENTAL CARE OF MICHIGAN, P.C.
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 28282 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-5604
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Country | US
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Telephone | 586-574-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 28282 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-5604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | COURTNEY MONTEITH
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Credential |
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Telephone | 217-540-8306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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