Organization
LIFETIME DENTAL CARE OF ILLINOIS, PC
Active
Other names
West Side Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KROEGER (INS COOD)
(217) 540-5100
Entity
Organization
Contact information
Practice address
2633 CHATHAM ROAD, SUITE A, SPRINGFIELD, IL 62704
(217) 698-8777
(217) 698-8787
Mailing address
2633 CHATHAM ROAD, SUITE A, SPRINGFIELD, IL 62704
(217) 698-8777
(217) 698-8787
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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