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General NPI Number Information
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NPI Number | 1568515278
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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 | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1820 WHITTAKER RD
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City | YPSILANTI
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State | MI
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Zip | 48197-9728
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Country | US
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Telephone | 734-480-3600
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Fax | 734-480-3606
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Provider Business Mailing Address
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Address Line | 1820 WHITTAKER RD
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City | YPSILANTI
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State | MI
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Zip | 48197-9728
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Country | US
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Telephone | 734-480-3600
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Fax | 734-480-3606
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Authorized Official
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Title or Position | INS COOD
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Name | AMY KROEGER
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Credential |
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Telephone | 217-540-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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