# LIFETIME DENTAL CARE OF INDIANA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Street Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780897009
- **Authorized official:** AMY KROEGER (INS COOD)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 103 NORTH FARABEE DRIVE, SUITE C, LAFAYETTE, IN 47905
- **Practice address phone:** (765) 447-7200
- **Practice address fax:** (765) 449-0976
- **Mailing address:** 103 NORTH FARABEE DRIVE, SUITE C, LAFAYETTE, IN 47905
- **Mailing address phone:** (765) 447-7200
- **Mailing address fax:** (765) 449-0976

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/07/2007
- **Last updated:** 08/22/2020