Organization
LIFETIME DENTAL CARE OF ILLINOIS, PC
Active
Other names
Dental Group of Carbondale
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KROEGER (INS COOD)
(217) 540-5100
Entity
Organization
Contact information
Practice address
1001 E MAIN, CARBONDALE, IL 62901
(618) 549-2273
(618) 351-0212
Mailing address
1001 E MAIN, CARBONDALE, IL 62901
(618) 549-2273
(618) 351-0212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/03/2007
Last updated
08/22/2020
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