NPIMap

Organization Active NPI

Lifelong Medical Care

Doing business as Lifelong Dental Care

  • General Practice Dentistry
  • Berkeley, CA
National Provider Identifier
1013913300
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LIFELONG MEDICAL CARE
Doing business as
Lifelong Dental Care
Practice address
1860 Alcatraz Ave
Berkeley, CA 94703-2715
Phone
(510) 653-8500
NPI assigned
Jun 22, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marty Lynch, N/A
Title
Ceo
Phone
(510) 981-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X CA Primary

Addresses

Primary practice location

1860 Alcatraz Ave
Berkeley, CA 94703-2715

Mailing address

PO Box 11247
Berkeley, CA 94712-2247
Phone (510) 981-4100

Other identifiers 1

IdentifierTypeStateIssuer
FHC70239FMedicaidCA

Other names 1

  • LIFELONG DENTAL CARE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013913300. Details of each certification follow.

  • CCN 051878 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 051878

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIFELONG DENTAL CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Facility address
1860 Alcatraz Avenue
Berkeley, CA 94703

National Provider Directory

National Provider Directory
Tax ID family
Lifelong Medical Center44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013913300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11247",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947122247",
            "telephone_number": "510-981-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 ALCATRAZ AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032715",
            "telephone_number": "510-653-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELONG MEDICAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-981-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N/A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70239F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFELONG DENTAL CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.