# LIFETIME DENTAL CAREOF INDIANA, PC

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

## Provider details

- **NPI number:** 1891917282
- **Authorized official:** AMY KROEGER (INS COOD)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 1605 NORTH IRONWOOD, SOUTH BEND, IN 46635
- **Practice address phone:** (574) 271-9693
- **Practice address fax:** (574) 271-9719
- **Mailing address:** 1605 NORTH IRONWOOD, SOUTH BEND, IN 46635
- **Mailing address phone:** (574) 271-9693
- **Mailing address fax:** (574) 271-9719

## Taxonomy

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

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/22/2020