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General NPI Number Information
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NPI Number | 1528271061
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Entity Type | Organization
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Legal Business Name | LIFETIME DENTAL CARE
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 276 E HARVARD BLVD
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City | SANTA PAULA
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State | CA
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Zip | 93060-3372
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Country | US
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Telephone | 805-933-9594
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Fax | 805-933-4548
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Provider Business Mailing Address
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Address Line | 276 E HARVARD BLVD
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City | SANTA PAULA
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State | CA
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Zip | 93060-3372
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Country | US
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Telephone | 805-933-9594
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Fax | 805-933-4548
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NICHOLAS H. KIM
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Credential | D.D.S.
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Telephone | 805-933-9594
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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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