Provider Demographics
NPI:1851006753
Name:LIFETIME FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:LIFETIME FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCKUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-713-7812
Mailing Address - Street 1:15309 S BUTTERCUP CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-3156
Mailing Address - Country:US
Mailing Address - Phone:708-263-3741
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 470
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9528
Practice Address - Country:US
Practice Address - Phone:815-717-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental