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Contact Information

LIFETIME DENTAL CARE OF ILLINOIS, PC
713 S. 42ND STREET
MOUNT VERNON, IL62864
 Phone: 618-244-9666
 Fax: 618-244-9986
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for LIFETIME DENTAL CARE OF ILLINOIS, PC

NPI # 1417179755
LBN Legal business name LIFETIME DENTAL CARE OF ILLINOIS, PC
Authorized official AMY KROEGER - (INS COOD)
Entity Organization
Organization subpart 1 No
Enumeration date 05/03/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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