MEDICARE: LIFETIME FAMILY DENTISTRY LLC

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	1223G0001X	General Practice Dentistry	4036	SC
2	1223G0001X	General Practice Dentistry	3380	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1457337495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	310 OWINGS ST
Second Line	:
City	:	LAURENS
State	:	SC
Zip	:	29360-2738
Country	:	US
Telephone Number	:	864-984-6888
Fax Number	:	864-984-4474

Provider Business Practice Location Address
First Line	:	310 OWINGS ST
Second Line	:
City	:	LAURENS
State	:	SC
Zip	:	29360-2738
Country	:	US
Telephone Number	:	864-984-6888
Fax Number	:	864-984-4474

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SUZANNE M LOWRY
Credential	:
Telephone Number	:	864-984-6888

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	08/22/2020

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Directions to “LIFETIME FAMILY DENTISTRY LLC ” Practice Location

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