Lifetime Dental LLC

NPI #1679024442 in Greenwood, Mississippi

Provider Information

NPI Number: 1679024442
Entity Type: Organization
Organization Name: Lifetime Dental LLC
Subpart: Yes (part of a larger organization)
Parent Organization: JOHNSON DENTAL CLINIC INC
Primary Specialty: Dentist
Enumeration Date: Oct 17, 2016
Last Updated: Oct 17, 2016

Practice Location

Address: 910 MEDALLION DR
City: Greenwood
State: Mississippi
ZIP Code: 38930-2118
Phone: (662) 843-8353

Authorized Official

Name: DARYL LANCE JOHNSON, DMD
Title: SOLE PROPRIETOR
Phone: (662) 843-8353

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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