Provider Demographics
NPI:1588374391
Name:ALSBURY AND LIFEWAY DENTAL PLLC
Entity type:Organization
Organization Name:ALSBURY AND LIFEWAY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, INSURANCE PLAN MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-424-2990
Mailing Address - Street 1:505 E HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:ALVARADO
Mailing Address - State:TX
Mailing Address - Zip Code:76009-3262
Mailing Address - Country:US
Mailing Address - Phone:817-587-8888
Mailing Address - Fax:
Practice Address - Street 1:505 E HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:ALVARADO
Practice Address - State:TX
Practice Address - Zip Code:76009-3262
Practice Address - Country:US
Practice Address - Phone:817-587-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty