Provider Demographics
NPI:1447087705
Name:LIFETIME DENTAL PLLC
Entity type:Organization
Organization Name:LIFETIME DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:YASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-929-6029
Mailing Address - Street 1:1843 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1148
Mailing Address - Country:US
Mailing Address - Phone:847-807-6024
Mailing Address - Fax:847-807-6028
Practice Address - Street 1:1843 W GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-1148
Practice Address - Country:US
Practice Address - Phone:312-929-6029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty