# LIFETIME DENTAL CARE OF MICHIGAN, PC

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

## Provider details

- **NPI number:** 1619739679
- **Legal business name:** LIFETIME DENTAL CARE OF MICHIGAN, PC
- **Authorized official:** CEMYIRA MCDOUGAL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 764-8609

## Contact information

- **Practice address:** 8110 COOLEY DR, PORTAGE, MI 49024-4046
- **Practice address phone:** (269) 382-3125
- **Practice address fax:** (269) 382-3125
- **Mailing address:** 8110 COOLEY DR, PORTAGE, MI 49024-4046

## Taxonomy

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

## Other

- **Enumeration date:** 01/25/2024
- **Last updated:** 03/14/2025