Provider Demographics
NPI:1336460690
Name:LIFETIME SMILES DENTAL CARE
Entity type:Organization
Organization Name:LIFETIME SMILES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:DONATO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-872-7909
Mailing Address - Street 1:2509 W CREST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6839
Mailing Address - Country:US
Mailing Address - Phone:813-872-7909
Mailing Address - Fax:
Practice Address - Street 1:2509 W CREST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6839
Practice Address - Country:US
Practice Address - Phone:813-872-7909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty