Lifetime Dental Care Of Illinois, PC
Dentist, General Practice in Springfield, IL. Organization (NPI-2).
NPI number1720200074
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1720200074
- Entity type
- Organization (NPI-2)
- Legal business name
- Lifetime Dental Care Of Illinois, PC
- Organization subpart
- No
- Enumeration date
- May 3, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Montvale Dental Center (Doing Business As)
Practice location
3124 Montvale DriveSpringfield, IL 62704
Phone 217-546-8777 · Fax 217-546-9547
Mailing address
3124 Montvale DriveSpringfield, IL 62704
Phone 217-546-8777 · Fax 217-546-9547
Authorized official
Amy Kroeger
Ins Cood
2175405100
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