Organization
LIFETIME DENTAL CARE OF INDIANA
Active
Other names
South Street Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KROEGER (INS COOD)
(217) 540-5100
Entity
Organization
Contact information
Practice address
103 NORTH FARABEE DRIVE, SUITE C, LAFAYETTE, IN 47905
(765) 447-7200
(765) 449-0976
Mailing address
103 NORTH FARABEE DRIVE, SUITE C, LAFAYETTE, IN 47905
(765) 447-7200
(765) 449-0976
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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