Provider Demographics
NPI:1588209548
Name:LIFETIME DENTAL CARE OF PENNSYLVANIA, P.C.
Entity Type:Organization
Organization Name:LIFETIME DENTAL CARE OF PENNSYLVANIA, P.C.
Other - Org Name:PINNACLE CENTER DENTAL IMPLANTS AND PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-6078
Mailing Address - Street 1:6200 STEUBENVILLE PIKE STE 201
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-4305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6200 STEUBENVILLE PIKE STE 201
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-4305
Practice Address - Country:US
Practice Address - Phone:412-787-8590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETIME DENTAL CARE OF PENNSYLVANIA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty