Provider Demographics
NPI:1760877179
Name:LIFETIME DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:LIFETIME DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-668-1147
Mailing Address - Street 1:1805 NW PLATTE ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 S. 65 HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340
Practice Address - Country:US
Practice Address - Phone:816-741-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO288028175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty