Lifetime Dental Care of Illinois, PC

NPI #1902028178 in Rockford, Illinois

Provider Information

NPI Number: 1902028178
Entity Type: Organization
Organization Name: Lifetime Dental Care of Illinois, PC
Primary Specialty: Dentist - General Practice
Enumeration Date: May 3, 2007
Last Updated: Mar 17, 2010

Practice Location

Address: 3065 N PERRYVILLE RD UNIT 125
City: Rockford
State: Illinois
ZIP Code: 61114-8036
Phone: (815) 637-2273

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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