| Lifetime Dental Care Of Illinois, Pc | |
|
1490 North Greenmount Road Suite A Ofallon IL 62269 | |
| (618) 622-9720 | |
| (618) 622-1700 |
| Full Name | Lifetime Dental Care Of Illinois, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1490 North Greenmount Road, Ofallon, Illinois |
| Authorized Official Name and Position | Amy Kroeger (INS COOD) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Dental Care Of Illinois, Pc 1490 North Greenmount Road Suite A Ofallon IL 62269 Ph: (618) 622-9720 | Lifetime Dental Care Of Illinois, Pc 1490 North Greenmount Road Suite A Ofallon IL 62269 Ph: (618) 622-9720 |
| NPI Number | 1376756635 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376756635 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Dental Professionals Of Illinois, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 Regency Park, Suite 2, Ofallon, IL 62269 Phone: 618-628-1646 Fax: 618-628-1643 | |
Lifetime Dental Care Of Illinois, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1490 North Greenmount Road, Suite B, Ofallon, IL 62269 Phone: 618-632-1603 Fax: 618-632-6034 |