NPIMap

Organization Active NPI

Lifetime Dental Care of Michigan, P.C.

Doing business as Jacobson Dental Group

  • General Practice Dentistry
  • Commerce Township, MI
National Provider Identifier
1396555603
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Doing business as
Jacobson Dental Group
Practice address
39890 W 14 Mile Rd
Commerce Township, MI 48390-3911
Phone
(248) 624-8090
NPI assigned
Jan 9, 2025
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFETIME DENTAL CARE OF MICHIGAN, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

39890 W 14 Mile Rd
Commerce Township, MI 48390-3911

Mailing address

39890 W 14 Mile Rd
Commerce Township, MI 48390-3911

Other names 1

  • Jacobson Dental Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250321002180 MI DME Supplier - Oral Surgery - Dentist 5890217525 Practice locations: Commerce Township, MI

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Dental Care of Michigan PC24 organizations share this tax ID, including this one
Part of
Lifetime Dental Care of Michigan PC

Other organizations with this tax ID 23

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

View all 23

Locations

39890 W 14 Mile Rd
Commerce Township, MI 48390
Phone (248) 624-8090

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1736380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1396555603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39890 W 14 MILE RD",
            "city": "COMMERCE TOWNSHIP",
            "state": "MI",
            "postal_code": "483903911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39890 W 14 MILE RD",
            "city": "COMMERCE TOWNSHIP",
            "state": "MI",
            "postal_code": "483903911",
            "telephone_number": "248-624-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF MICHIGAN, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFETIME DENTAL CARE OF MICHIGAN, P.C.",
        "enumeration_date": "2025-01-09",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacobson Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Commerce Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.