Provider Demographics
NPI:1720862253
Name:LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Entity Type:Organization
Organization Name:LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:2887 10 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9100
Mailing Address - Country:US
Mailing Address - Phone:616-433-2250
Mailing Address - Fax:616-433-2252
Practice Address - Street 1:2887 10 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9100
Practice Address - Country:US
Practice Address - Phone:616-433-2250
Practice Address - Fax:616-433-2252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty