Organization · Type 2 NPI

Lifetime Dental Care of Illinois, PC

General Practice Dentistry · Ofallon, IL

NPI number 1376756635 Active

Practice location

1490 North Greenmount Road, Suite A
Ofallon, IL 62269

Fax (618) 622-1700

Specialties and licenses

Taxonomy	Code	License
General Practice Dentistry Primary	1223G0001X	None listed

General Practice Dentistry: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Another provider at this address

Lifetime Dental Care of Illinois, PCGeneral Practice Dentistry Ofallon, IL NPI 1851513238

Other general practice dentistry providers in Ofallon

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NPI record

NPI: 1376756635
Entity type: Organization (Type 2)
Issued: May 7, 2007
Last updated: May 21, 2008
Status: Active
Subpart: Yes of Lifetime Dental Care of Illinois, PC

Other names

<unavail>
Green Mount Family Dentistry · doing business as

Authorized official

Amy Kroeger
Ins Cood
(217) 540-5100

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1376756635

Lifetime Dental Care of Illinois, PC's National Provider Identifier is 1376756635, issued on May 7, 2007. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in Ofallon, IL. The record was last updated on May 21, 2008.