MEDICARE: LIFETIME DENTAL CARE

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
1	122300000X	Dentist	0401411101	VA

General Provider Information

NPI Number	:	1255685707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME DENTAL CARE

Provider Business Mailing Address
First Line	:	14573 POTOMAC MILLS RD
Second Line	:
City	:	WOODBRIDGE
State	:	MD
Zip	:	22192
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14573 POTOMAC MILLS RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-6808
Country	:	US
Telephone Number	:	240-463-1824
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEONARD TOYER II
Credential	:	D.D.S.
Telephone Number	:	804-241-1390

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	04/06/2023

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Directions to “LIFETIME DENTAL CARE ” Practice Location

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