| Lifetime Dental Care Of Illinois, Pc | |
|
713 S. 42nd Street Mt. Vernon IL 62864 | |
| (618) 244-9666 | |
| (618) 244-9986 |
| Full Name | Lifetime Dental Care Of Illinois, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 713 S. 42nd Street, Mt. Vernon, 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 713 S. 42nd Street Mt. Vernon IL 62864 Ph: (618) 244-9666 | Lifetime Dental Care Of Illinois, Pc 713 S. 42nd Street Mt. Vernon IL 62864 Ph: (618) 244-9666 |
| NPI Number | 1417179755 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417179755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |