NPIMap

Organization Active NPI

Lifetime Dental, Inc

  • General Practice Dentistry
  • Tavares, FL
National Provider Identifier
1497906705
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN8245 Issued in FL
Legal business name
LIFETIME DENTAL, INC
Practice address
215 E Burleigh Blvd
Tavares, FL 32778-2403
Phone
(352) 253-6400
Fax
(352) 253-6401
NPI assigned
Oct 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

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

Authorized official

Name
Mr. Charles William Reinertsen, D.M.D.NPI 1922130764
Title
Owner/Dentist
Phone
(352) 253-6400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN8245 FL Primary

Addresses

Primary practice location

215 E Burleigh Blvd
Tavares, FL 32778-2403

Mailing address

215 E Burleigh Blvd
Tavares, FL 32778-2403
Phone (352) 253-6400

Other names 1

  • Tavares Dental Excellence, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

215 E Burleigh Blvd
Tavares, FL 32778
Phone (352) 253-6400

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1223251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1497906705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E BURLEIGH BLVD",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327782403",
            "telephone_number": "352-253-6400",
            "fax_number": "352-253-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E BURLEIGH BLVD",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327782403",
            "telephone_number": "352-253-6400",
            "fax_number": "352-253-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-06",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "REINERTSEN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "352-253-6400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN8245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tavares Dental Excellence, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Tavares, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.