Organization
LIFETIME DENTAL CARE OF ILLINOIS, PC
Active
Parent organization
LIFETIME DENTAL CARE OF ILLINOIS, PC
Other names
Green Mount Family Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFETIME DENTAL CARE OF ILLINOIS, PC
Authorized official
AMY KROEGER (INS COOD)
(217) 540-5100
Entity
Organization
Contact information
Practice address
1490 NORTH GREENMOUNT ROAD, SUITE A, OFALLON, IL 62269
(618) 622-9720
(618) 622-1700
Mailing address
1490 NORTH GREENMOUNT ROAD, SUITE A, OFALLON, IL 62269
(618) 622-9720
(618) 622-1700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/07/2007
Last updated
05/21/2008
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