Lifetime Dental, INC
Dentist, General Practice in Tavares, FL. Organization (NPI-2).
NPI number1497906705
StatusActive
Last updated in NPPESFeb 21, 2018
Details
- NPI
- 1497906705
- Entity type
- Organization (NPI-2)
- Legal business name
- Lifetime Dental, INC
- Organization subpart
- No
- Enumeration date
- Oct 6, 2008
- Last updated
- Feb 21, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | DN8245 | FL | Yes |
Other names
- Tavares Dental Excellence, LLC (Former Legal Business Name)
Practice location
215 E Burleigh BlvdTavares, FL 32778-2403
Phone 352-253-6400 · Fax 352-253-6401
Mailing address
215 E Burleigh BlvdTavares, FL 32778-2403
Phone 352-253-6400 · Fax 352-253-6401
Authorized official
Charles William Reinertsen
Owner/Dentist
3522536400
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