Lifetime Dental Care of Wisconsin, S.c.

NPI #1558975177 in Salem, Wisconsin

Provider Information

NPI Number: 1558975177
Entity Type: Organization
Organization Name: Lifetime Dental Care of Wisconsin, S.c.
Subpart: Yes (part of a larger organization)
Parent Organization: HEARTLAND DENTAL
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 1, 2020
Last Updated: Dec 6, 2022

Practice Location

Address: 24418 75TH ST
City: Salem
State: Wisconsin
ZIP Code: 53168-9703
Phone: (262) 843-2004

Authorized Official

Name: COURTNEY MONTEITH
Title: CREDENTIALING COORDINATOR
Phone: (217) 540-8306

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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