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LIFETIME DENTAL CARE OF ILLINOIS PC NPI 1265654412


NPI Information

NPI: 1265654412
Provider Name: LIFETIME DENTAL CARE OF ILLINOIS, PC

Doing Business As: DENTAL GROUP OF BLOOMINGTON

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
1507 NORTH VETERANS PARKWAY
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 664-6666
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LIFETIME DENTAL CARE OF ILLINOIS, PC is a general practice dentist in Bloomington, IL. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. LIFETIME DENTAL CARE OF ILLINOIS, PC NPI is 1265654412. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dental Group Of Bloomington.

The provider's business location address is:

1507 NORTH VETERANS PARKWAY
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 664-6666
Fax: (309) 662-0252

The provider's authorized official is Amy Kroeger .
The authorized official title is Ins Cood and has the following contact phone number (217) 540-5100.

The enumeration date for this NPI number is 5/3/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.