# LIFETIME DENTAL OF MACOMB PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710816459
- **Authorized official:** MARK OUSACHI (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (586) 940-0123

## Contact information

- **Practice address:** 28050 HARPER AVE, SAINT CLAIR SHORES, MI 48081-1562
- **Practice address phone:** (586) 774-6655
- **Mailing address:** 3024 MANGROVE DR, STERLING HEIGHTS, MI 48314-4407
- **Mailing address phone:** (586) 940-0123

## Taxonomy

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

## Other

- **Enumeration date:** 05/18/2026
- **Last updated:** 05/18/2026