Organization
LIFETIME DENTAL CARE OF ILLINOIS, PC
Active
Other names
Dental Group of Rockford
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KROEGER (INS COOD)
(217) 540-5100
Entity
Organization
Contact information
Practice address
3065 N PERRYVILLE RD UNIT 125, ROCKFORD, IL 61114-8036
(815) 637-2273
(815) 637-2466
Mailing address
3065 N PERRYVILLE RD UNIT 125, ROCKFORD, IL 61114-8036
(815) 637-2273
(815) 637-2466
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/03/2007
Last updated
03/17/2010
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