Provider Demographics
NPI:1912235730
Name:LIFETIMESMILES LLC
Entity Type:Organization
Organization Name:LIFETIMESMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:WHEELER
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:IPDH
Authorized Official - Phone:207-232-4836
Mailing Address - Street 1:3 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1301
Mailing Address - Country:US
Mailing Address - Phone:207-232-4836
Mailing Address - Fax:
Practice Address - Street 1:3 CARRIAGE RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND FORESIDE
Practice Address - State:ME
Practice Address - Zip Code:04110-1301
Practice Address - Country:US
Practice Address - Phone:207-232-4836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty