MEDICARE: LIFETIME ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1750176467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME ORTHODONTICS

Provider Business Mailing Address
First Line	:	4635 KINGWOOD DR STE 600
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-2647
Country	:	US
Telephone Number	:	346-771-3939
Fax Number	:	346-771-3955

Provider Business Practice Location Address
First Line	:	4635 KINGWOOD DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77345-2359
Country	:	US
Telephone Number	:	346-771-3939
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIELLE MILLER
Credential	:	DDS, MSD
Telephone Number	:	346-771-3939

Provider Enumeration Date	:	04/12/2025
Last Update Date	:	12/08/2025

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Directions to “LIFETIME ORTHODONTICS ” Practice Location

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