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General NPI Number Information
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NPI Number | 1669880845
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Entity Type | Organization
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Legal Business Name | LIFETIME DENTAL PARTNERS, PLLC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 321 BRIGGS AVE S SUITE 3
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City | PARK RIVER
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State | ND
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Zip | 58270
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Country | US
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Telephone | 701-284-7777
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Fax | 701-284-6776
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Provider Business Mailing Address
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Address Line | 927 W 12TH ST
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City | GRAFTON
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State | ND
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Zip | 58237-2121
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Country | US
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Telephone | 701-352-2450
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Fax | 701-352-2424
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTA LEA EKMAN
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Credential | DDS
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Telephone | 701-352-2450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1904
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License Number State | ND
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