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Organization

LIFETIME DENTAL CARE OF ILLINOIS, PC

Active
Other names
Dental Group of Springfield
Organization subpart
No

Provider details

NPI number
Authorized official
CELIA HAYES (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization

Contact information

Practice address
2701 S KOKE MILL RD, SPRINGFIELD, IL 62711-8194
(217) 793-8899
(217) 793-9662
Mailing address
2701 S KOKE MILL RD, SPRINGFIELD, IL 62711-8194
(217) 793-8899
(217) 793-9662

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
05/07/2007
Last updated
02/01/2022
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