NPIMap

Organization Active NPI

Lifetime Dental Care of Michigan, P.C.

  • Dentist
  • Woodhaven, MI
National Provider Identifier
1891848594
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LIFETIME DENTAL CARE OF MICHIGAN, P.C.
Doing business as
Brownstown Dental Care
Practice address
23450 Allen Rd
Woodhaven, MI 48183-3376
Phone
(734) 479-1200
Fax
(734) 479-1277
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

23450 Allen Rd
Woodhaven, MI 48183-3376

Mailing address

23450 Allen Rd
Woodhaven, MI 48183-3376
Phone (734) 479-1200

Other names 1

  • Brownstown Dental Care Doing business as

National Provider Directory

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

Other organizations with this tax ID 23

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

View all 23

Locations

19249 Allen Rd
Brownstown Twp, MI 48183
Phone (734) 479-2990

23450 Allen Rd
Woodhaven, MI 48183
Phone (734) 479-1200

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1891848594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23450 ALLEN RD",
            "city": "WOODHAVEN",
            "state": "MI",
            "postal_code": "481833376",
            "telephone_number": "734-479-1200",
            "fax_number": "734-479-1277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23450 ALLEN RD",
            "city": "WOODHAVEN",
            "state": "MI",
            "postal_code": "481833376",
            "telephone_number": "734-479-1200",
            "fax_number": "734-479-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF MICHIGAN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brownstown Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodhaven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.