| NPI | 1528506532 |
|---|---|
| Doing Business As | LIFETIME DENTAL AT SAN PEDRO |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA TEUTSCH Credentialing Coordinator 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |