# LIFETIME DENTAL CARE OF MICHIGAN, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LIFETIME DENTAL CARE OF MICHIGAN, PC
- **Other names:** The Lakes Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1316305063
- **Legal business name:** LIFETIME DENTAL CARE OF MICHIGAN, PC
- **Authorized official:** KENDRA WALKER (CREDENTIALING TEAM LEAD)
- **Authorized official phone:** (217) 540-8312

## Contact information

- **Practice address:** 6127 RAWSONVILLE RD, SUITE 118, BELLEVILLE, MI 48111-2546
- **Practice address phone:** (734) 720-9827
- **Mailing address:** 6127 RAWSONVILLE RD, SUITE 118, BELLEVILLE, MI 48111-2546

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2016
- **Last updated:** 02/29/2016