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NPI Code Detail

MEDICARE: LIFETIME DENTAL PLLC

MEDICARE: LIFETIME DENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2826-94MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053573725
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFETIME DENTAL PLLC
Provider Business Mailing Address
First Line : 1313 W HIGHWAY 8
Second Line :
City : CLEVELAND
State : MS
Zip : 38732-2240
Country : US
Telephone Number : 662-843-8353
Fax Number : 662-843-8363
Provider Business Practice Location Address
First Line : 1313 W HIGHWAY 8
Second Line :
City : CLEVELAND
State : MS
Zip : 38732-2240
Country : US
Telephone Number : 662-843-8353
Fax Number : 662-843-8363
Authorized Official
Title or Position : PARTNER
Name : DR. HAMILTON M BROWN
Credential : DMD
Telephone Number : 662-843-8353
Provider Enumeration Date : 06/25/2008
Last Update Date : 11/23/2022

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Directions to “LIFETIME DENTAL PLLC ” Practice Location

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