Lifetime Dental Care of Illinois, PC

NPI #1487866919 in Peoria, Illinois

Provider Information

NPI Number: 1487866919
Entity Type: Organization
Organization Name: Lifetime Dental Care of Illinois, PC
Subpart: Yes (part of a larger organization)
Parent Organization: LIFETIME DENTAL CARE OF ILLINOIS, PC
Primary Specialty: Dentist - General Practice
Enumeration Date: May 4, 2007
Last Updated: May 21, 2008

Practice Location

Address: 7310 N. VILLA LAKE DRIVE
Address 2: SUITE B
City: Peoria
State: Illinois
ZIP Code: 61614
Phone: (309) 691-9072

Authorized Official

Name: AMY KROEGER
Title: INS COOD
Phone: (217) 540-5100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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