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General NPI Number Information
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NPI Number | 1497906705
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Entity Type | Organization
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Legal Business Name | LIFETIME DENTAL, INC
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 215 E BURLEIGH BLVD
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City | TAVARES
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State | FL
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Zip | 32778-2403
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Country | US
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Telephone | 352-253-6400
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Fax | 352-253-6401
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Provider Business Mailing Address
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Address Line | 215 E BURLEIGH BLVD
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City | TAVARES
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State | FL
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Zip | 32778-2403
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Country | US
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Telephone | 352-253-6400
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Fax | 352-253-6401
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MR. CHARLES WILLIAM REINERTSEN
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Credential | D.M.D.
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Telephone | 352-253-6400
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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 | DN8245
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License Number State | FL
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