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General NPI Number Information
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NPI Number | 1770055071
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Entity Type | Organization
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Legal Business Name | LIFETIME DENTAL PLLC
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 2200 S MINNESOTA AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57105-3748
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Country | US
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Telephone | 801-694-7042
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W 10TH ST APT 1
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City | DELL RAPIDS
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State | SD
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Zip | 57022-1223
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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 | OWNER
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Name | SARA ROBISON
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Credential | DMD
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Telephone | 801-694-7042
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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 |
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License Number State |
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