# 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:** Wolf Creek Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1922500917
- **Legal business name:** LIFETIME DENTAL CARE OF MICHIGAN, P.C.
- **Authorized official:** CASSANDRA PETERSEN (CREDENTIALING TEAM LEAD)
- **Authorized official phone:** (217) 540-8972

## Contact information

- **Practice address:** 1136 COUNTRY CLUB RD STE B, ADRIAN, MI 49221-8208
- **Practice address phone:** (517) 263-9022
- **Mailing address:** 1136 COUNTRY CLUB RD STE B, ADRIAN, MI 49221-8208
- **Mailing address phone:** (517) 263-9022

## Taxonomy

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

## Other

- **Enumeration date:** 03/06/2018
- **Last updated:** 03/06/2018