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Organization
LIFETIME DENTAL CARE OF INDIANA
Active
Organization
LIFETIME DENTAL CARE OF INDIANA
Active
Other names
South Street Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KROEGER (INS COOD)
(217) 540-5100
Entity
Organization
Contact information
Practice address
103 NORTH FARABEE DRIVE, SUITE C, LAFAYETTE, IN 47905
(765) 447-7200
(765) 449-0976
Mailing address
103 NORTH FARABEE DRIVE, SUITE C, LAFAYETTE, IN 47905
(765) 447-7200
(765) 449-0976
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/07/2007
Last updated
08/22/2020
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