# LIFETIME DENTAL CARE OF MICHIGAN, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LIFETIME DENTAL CARE OF MICHIGAN, P.C.
- **Other names:** Jacobson Dental Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396555603
- **Legal business name:** LIFETIME DENTAL CARE OF MICHIGAN, P.C.
- **Authorized official:** CEMYIRA MCDOUGAL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 764-8609

## Contact information

- **Practice address:** 39890 W 14 MILE RD, COMMERCE TOWNSHIP, MI 48390-3911
- **Practice address phone:** (248) 624-8090
- **Mailing address:** 39890 W 14 MILE RD, COMMERCE TOWNSHIP, MI 48390-3911

## Taxonomy

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

## Other

- **Enumeration date:** 01/09/2025
- **Last updated:** 01/09/2025