Provider Demographics
NPI:1891848594
Name:LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Entity Type:Organization
Organization Name:LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Other - Org Name:BROWNSTOWN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:23450 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3376
Mailing Address - Country:US
Mailing Address - Phone:734-479-1200
Mailing Address - Fax:734-479-1277
Practice Address - Street 1:23450 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3376
Practice Address - Country:US
Practice Address - Phone:734-479-1200
Practice Address - Fax:734-479-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty